Spontaneous Reversion from Long‐Lasting Atrial Fibrillation to Sinus Rhythm

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Abstract
Cases [23] with atrial fibrillation (AF) of 3-29 yr duration with spontaneous reversion to sinus rhythm (SR) were collected. Similar cases [22] were identified in the literature. Several patients spent several years with different atrial arrhythmias before a stable SR was established. Of all 45 cases, 39 had significant rheumatic mitral valve disease. In the majority of these patients, the ECG shows 1st degree atrioventricular block after return to SR and a low-amplitude P-wave.sbd.as if the left atrial P component was lacking. There are no signs of left atrial mechanical activity after re-establishment of SR in the mitral valve disease group, as judged from phonocardiograms, apexcardiograms, echocardiograms and left atrial pressure recordings in selected patients. Heart muscle biopsy was obtained from 2 patients who underwent mitral valve surgery. Left atrial specimens showed almost complete lack of all muscle structures. There is electrical, mechanical and histological evidence of left atrial muscle deterioration. The electrophysiological factors responsible for initiation and maintenance of AF evidently disappeared with this deterioration, allowing SR to be re-established. The return of SR might indicate a progress of the heart disease, although the patient may benefit from normalization of cardiac rate and regularity. The phenomenon of appearance of late SR is evidently far more common than suggested up to now.