(1) stromal cell-derived factor
(2) pro-atrial natriuretic peptide
(3) ACE inhibitors or angiotensin II receptor blockers
CV failure was less common in patients on amiodarone (29% vs 65%) and high levels of transforming growth factor (TGF-beta) were associated with immediate CV failure. Recurrence of afib following a successful CV (after adjusting for confounding variables) was more common in patients older than 60 years, those with SEC, and those with low levels of SDF-1 alpha. Under-utilization of ACE inhibitors, ARBs, and spironolactone was associated with a greater risk of recurrence. Left atrial diameter and level of C-reactive protein were not associated with recurrence.
Kim, SK, et al. Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion. Europace, Vol. 11, December 2009, pp. 1632-38
Editor's comment: This study clearly shows that remaining in sinus rhythm after a seemingly successful CV is the exception rather than the rule. It is unfortunate that the researchers did not measure potassium and magnesium levels prior to the procedure. It is likely that they would have been found to be low in light of the seemingly beneficial effect of potassium- and magnesium-sparing drugs (ACE inhibitors, ARBS, and spironolactone). In any case, it is important to ensure adequate potassium and magnesium stores prior to a CV and it may well be that taking one of the above-mentioned drugs prior to and after a CV may extend the time to recurrence.