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Gregory Y.h. Lip - One of the best experts on this subject based on the ideXlab platform.
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Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and Permanent Atrial Fibrillation. Effects of cardioversion and return of left Atrial function
European heart journal, 2001Co-Authors: Foo Leong Li-saw-hee, Andrew D. Blann, D. Gurney, Gregory Y.h. LipAbstract:Background Atrial Fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic Atrial Fibrillation patients, that is, in those with paroxysmal, persistent or Permanent Atrial Fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent Atrial Fibrillation and the return of left Atrial function. Patients and Methods We studied 69 patients with chronic Atrial Fibrillation: 23 with paroxysmal Atrial Fibrillation (16 males; mean age 65 years±SD13); 23 with persistent Atrial Fibrillation (16 males; 65 years±13), with a mean duration of Atrial Fibrillation of 3 months (range 2 to 6 months); and 23 with Permanent Atrial Fibrillation (16 males; 67 years±10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent Atrial Fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction). Results Permanent Atrial Fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P
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plasma von willebrand factor fibrinogen and soluble p selectin levels in paroxysmal persistent and Permanent Atrial Fibrillation effects of cardioversion and return of left Atrial function
European Heart Journal, 2001Co-Authors: Foo Leong Lisawhee, Andrew D. Blann, D. Gurney, Gregory Y.h. LipAbstract:Background Atrial Fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic Atrial Fibrillation patients, that is, in those with paroxysmal, persistent or Permanent Atrial Fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent Atrial Fibrillation and the return of left Atrial function. Patients and Methods We studied 69 patients with chronic Atrial Fibrillation: 23 with paroxysmal Atrial Fibrillation (16 males; mean age 65 years±SD13); 23 with persistent Atrial Fibrillation (16 males; 65 years±13), with a mean duration of Atrial Fibrillation of 3 months (range 2 to 6 months); and 23 with Permanent Atrial Fibrillation (16 males; 67 years±10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent Atrial Fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction). Results Permanent Atrial Fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P <0·001); paroxysmal Atrial Fibrillation with significantly elevated levels of plasma von Willebrand factor ( P =0·0067) and fibrinogen ( P =0·0001) but not soluble P-selectin ( P =0·472); and persistent Atrial Fibrillation with normal levels of fibrinogen, von Willebrand factor and soluble P-selectin when compared to healthy controls (all P =ns). Stepwise multiple regression analyses demonstrated that the presence of Atrial Fibrillation was an independent predictor of abnormal von Willebrand factor, fibrinogen and soluble P-selectin levels. Electrical cardioversion of the patients with persistent Atrial Fibrillation did not significantly alter levels of von Willebrand factor ( P =0·766), soluble P-selectin ( P =0·726) or fibrinogen ( P =0·50) despite maintenance of sinus rhythm and a significant return of left Atrial systolic function (as quantified by the presence of A wave on Doppler echocardiography) at 3 months. Conclusion There were significant differences in the prothrombotic state when patients with paroxysmal and Permanent Atrial Fibrillation are compared to matched patients with persistent Atrial Fibrillation or controls in sinus rhythm. Cardioversion of persistent Atrial Fibrillation did not significantly alter indices of hypercoagulability even after 3 months maintenance of sinus rhythm, despite the return of Atrial systole.
Ivo A Nesralla - One of the best experts on this subject based on the ideXlab platform.
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Randomized study of surgical isolation of the pulmonary veins for correction of Permanent Atrial Fibrillation associated with mitral valve disease.
The Journal of thoracic and cardiovascular surgery, 2009Co-Authors: Álvaro Albrecht, Gustavo Glotz De Lima, Renato A K Kalil, Rogerio Abrahao, João Ricardo M. Sant'anna, Luciana El Halal Schuch, Ivo A NesrallaAbstract:Objective Chronic Permanent Atrial Fibrillation is often due to mitral valve disease. The Cox maze procedure is the gold standard for treating this arrhythmia. Simpler techniques and ablation methods should have their efficacy tested in clinical practice. Our objective was to evaluate the effectiveness of surgical pulmonary vein isolation as compared with the Cox maze procedure. Methods Sixty patients were randomly assigned to control group, modified maze group (Cox maze III), and surgical isolation of the pulmonary veins (SPVI) group from July 1999 to October 2004. All patients had mitral valve lesions treated concomitantly. Preoperative characteristics were similar between groups. Results There were 4 deaths: 3 in the Cox maze group and 1 in the SPVI group ( P = .31). The Cox maze group presented longer times of extracorporeal circulation and myocardial ischemia ( P P P = .002; 95% confidence intervals: 0.07–0.56) as compared with the control group. No difference was found between the SPVI and Cox maze groups concerning prevention of Atrial Fibrillation recurrence (relative risk: 0.358; P = .215; 95% confidence intervals: 0.08–1.67). Conclusions The modified Cox maze procedure and surgical pulmonary vein isolation were similarly effective in restoring sinus or regular rhythm in Permanent Atrial Fibrillation associated with mitral valve disease. These results favor the adoption of surgical isolation as a preferable technique, simpler and equally effective in controlling Atrial Fibrillation. The results also can bring further information for understanding the mechanisms involved in origins and treatment of chronic Permanent Atrial Fibrillation.
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randomized study of surgery for patients with Permanent Atrial Fibrillation as a result of mitral valve disease
The Annals of Thoracic Surgery, 2004Co-Authors: Gustavo Glotz De Lima, Renato A K Kalil, Tiago Luiz Luz Leiria, Domingos Hatem, Claudio L Kruse, Rogerio Abrahao, Joao Ricardo M Santanna, Paulo R Prates, Ivo A NesrallaAbstract:Abstract Background The Cox Maze procedure has been used to treat Atrial Fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with Atrial Fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate Permanent Atrial Fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery. Methods A prospective clinical trial of 30 patients with mitral valve disease and Permanent Atrial Fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1) associated en bloc isolation of pulmonary veins, (2) the Maze procedure, or (3) mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups. Results The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of Atrial Fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins ( p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group ( p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group. Conclusions En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with Permanent Atrial Fibrillation.
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Randomized study of surgery for patients with Permanent Atrial Fibrillation as a result of mitral valve disease
The Annals of thoracic surgery, 2004Co-Authors: Gustavo Glotz De Lima, Renato A K Kalil, Tiago Luiz Luz Leiria, Domingos Hatem, Claudio L Kruse, Rogerio Abrahao, Paulo R Prates, João Ricardo M. Sant'anna, Ivo A NesrallaAbstract:Abstract Background The Cox Maze procedure has been used to treat Atrial Fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with Atrial Fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate Permanent Atrial Fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery. Methods A prospective clinical trial of 30 patients with mitral valve disease and Permanent Atrial Fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1) associated en bloc isolation of pulmonary veins, (2) the Maze procedure, or (3) mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups. Results The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of Atrial Fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins ( p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group ( p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group. Conclusions En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with Permanent Atrial Fibrillation.
Per Blomström - One of the best experts on this subject based on the ideXlab platform.
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dronedarone in high risk Permanent Atrial Fibrillation
The New England Journal of Medicine, 2011Co-Authors: Stuart J. Connolly, Jonathan L. Halperin, Campbell D. Joyner, Marco Alings, John Amerena, Dan Atar, Alvaro Avezum, Per Blomström, John A Camm, Martin BorggrefeAbstract:A b s t r ac t Background Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent Atrial Fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular anti-arrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk Permanent Atrial Fibrillation. Methods
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Dronedarone in High-Risk Permanent Atrial Fibrillation
The New England journal of medicine, 2011Co-Authors: Stuart J. Connolly, A. John Camm, Jonathan L. Halperin, Campbell D. Joyner, Marco Alings, John Amerena, Dan Atar, Alvaro Avezum, Per Blomström, Martin BorggrefeAbstract:Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent Atrial Fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk Permanent Atrial Fibrillation. We assigned patients who were at least 65 years of age with at least a 6-month history of Permanent Atrial Fibrillation and risk factors for major vascular events to receive dronedarone or placebo. The first coprimary outcome was stroke, myocardial infarction, systemic embolism, or death from cardiovascular causes. The second coprimary outcome was unplanned hospitalization for a cardiovascular cause or death. After the enrollment of 3236 patients, the study was stopped for safety reasons. The first coprimary outcome occurred in 43 patients receiving dronedarone and 19 receiving placebo (hazard ratio, 2.29; 95% confidence interval [CI], 1.34 to 3.94; P=0.002). There were 21 deaths from cardiovascular causes in the dronedarone group and 10 in the placebo group (hazard ratio, 2.11; 95% CI, 1.00 to 4.49; P=0.046), including death from arrhythmia in 13 patients and 4 patients, respectively (hazard ratio, 3.26; 95% CI, 1.06 to 10.00; P=0.03). Stroke occurred in 23 patients in the dronedarone group and 10 in the placebo group (hazard ratio, 2.32; 95% CI, 1.11 to 4.88; P=0.02). Hospitalization for heart failure occurred in 43 patients in the dronedarone group and 24 in the placebo group (hazard ratio, 1.81; 95% CI, 1.10 to 2.99; P=0.02). Dronedarone increased rates of heart failure, stroke, and death from cardiovascular causes in patients with Permanent Atrial Fibrillation who were at risk for major vascular events. Our data show that this drug should not be used in such patients. (Funded by Sanofi-Aventis; PALLAS ClinicalTrials.gov number, NCT01151137.).
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a randomized double blind study of epicardial left Atrial cryoablation for Permanent Atrial Fibrillation in patients undergoing mitral valve surgery the swedish multicentre Atrial Fibrillation study swedmaf
European Heart Journal, 2007Co-Authors: Carina Blomstromlundqvist, Birgitta Johansson, Eva Berglin, L Nilsson, Steen M Jensen, Stefan Thelin, Anders Holmgren, Nils Edvardsson, Goran Kallner, Per BlomströmAbstract:A randomized double-blind study of epicardial left Atrial cryoablation for Permanent Atrial Fibrillation in patients undergoing mitral valve surgery : the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF).
D. Gurney - One of the best experts on this subject based on the ideXlab platform.
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Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and Permanent Atrial Fibrillation. Effects of cardioversion and return of left Atrial function
European heart journal, 2001Co-Authors: Foo Leong Li-saw-hee, Andrew D. Blann, D. Gurney, Gregory Y.h. LipAbstract:Background Atrial Fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic Atrial Fibrillation patients, that is, in those with paroxysmal, persistent or Permanent Atrial Fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent Atrial Fibrillation and the return of left Atrial function. Patients and Methods We studied 69 patients with chronic Atrial Fibrillation: 23 with paroxysmal Atrial Fibrillation (16 males; mean age 65 years±SD13); 23 with persistent Atrial Fibrillation (16 males; 65 years±13), with a mean duration of Atrial Fibrillation of 3 months (range 2 to 6 months); and 23 with Permanent Atrial Fibrillation (16 males; 67 years±10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent Atrial Fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction). Results Permanent Atrial Fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P
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plasma von willebrand factor fibrinogen and soluble p selectin levels in paroxysmal persistent and Permanent Atrial Fibrillation effects of cardioversion and return of left Atrial function
European Heart Journal, 2001Co-Authors: Foo Leong Lisawhee, Andrew D. Blann, D. Gurney, Gregory Y.h. LipAbstract:Background Atrial Fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic Atrial Fibrillation patients, that is, in those with paroxysmal, persistent or Permanent Atrial Fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent Atrial Fibrillation and the return of left Atrial function. Patients and Methods We studied 69 patients with chronic Atrial Fibrillation: 23 with paroxysmal Atrial Fibrillation (16 males; mean age 65 years±SD13); 23 with persistent Atrial Fibrillation (16 males; 65 years±13), with a mean duration of Atrial Fibrillation of 3 months (range 2 to 6 months); and 23 with Permanent Atrial Fibrillation (16 males; 67 years±10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent Atrial Fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction). Results Permanent Atrial Fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P <0·001); paroxysmal Atrial Fibrillation with significantly elevated levels of plasma von Willebrand factor ( P =0·0067) and fibrinogen ( P =0·0001) but not soluble P-selectin ( P =0·472); and persistent Atrial Fibrillation with normal levels of fibrinogen, von Willebrand factor and soluble P-selectin when compared to healthy controls (all P =ns). Stepwise multiple regression analyses demonstrated that the presence of Atrial Fibrillation was an independent predictor of abnormal von Willebrand factor, fibrinogen and soluble P-selectin levels. Electrical cardioversion of the patients with persistent Atrial Fibrillation did not significantly alter levels of von Willebrand factor ( P =0·766), soluble P-selectin ( P =0·726) or fibrinogen ( P =0·50) despite maintenance of sinus rhythm and a significant return of left Atrial systolic function (as quantified by the presence of A wave on Doppler echocardiography) at 3 months. Conclusion There were significant differences in the prothrombotic state when patients with paroxysmal and Permanent Atrial Fibrillation are compared to matched patients with persistent Atrial Fibrillation or controls in sinus rhythm. Cardioversion of persistent Atrial Fibrillation did not significantly alter indices of hypercoagulability even after 3 months maintenance of sinus rhythm, despite the return of Atrial systole.
Andrew D. Blann - One of the best experts on this subject based on the ideXlab platform.
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Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and Permanent Atrial Fibrillation. Effects of cardioversion and return of left Atrial function
European heart journal, 2001Co-Authors: Foo Leong Li-saw-hee, Andrew D. Blann, D. Gurney, Gregory Y.h. LipAbstract:Background Atrial Fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic Atrial Fibrillation patients, that is, in those with paroxysmal, persistent or Permanent Atrial Fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent Atrial Fibrillation and the return of left Atrial function. Patients and Methods We studied 69 patients with chronic Atrial Fibrillation: 23 with paroxysmal Atrial Fibrillation (16 males; mean age 65 years±SD13); 23 with persistent Atrial Fibrillation (16 males; 65 years±13), with a mean duration of Atrial Fibrillation of 3 months (range 2 to 6 months); and 23 with Permanent Atrial Fibrillation (16 males; 67 years±10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent Atrial Fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction). Results Permanent Atrial Fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P
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plasma von willebrand factor fibrinogen and soluble p selectin levels in paroxysmal persistent and Permanent Atrial Fibrillation effects of cardioversion and return of left Atrial function
European Heart Journal, 2001Co-Authors: Foo Leong Lisawhee, Andrew D. Blann, D. Gurney, Gregory Y.h. LipAbstract:Background Atrial Fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic Atrial Fibrillation patients, that is, in those with paroxysmal, persistent or Permanent Atrial Fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent Atrial Fibrillation and the return of left Atrial function. Patients and Methods We studied 69 patients with chronic Atrial Fibrillation: 23 with paroxysmal Atrial Fibrillation (16 males; mean age 65 years±SD13); 23 with persistent Atrial Fibrillation (16 males; 65 years±13), with a mean duration of Atrial Fibrillation of 3 months (range 2 to 6 months); and 23 with Permanent Atrial Fibrillation (16 males; 67 years±10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent Atrial Fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction). Results Permanent Atrial Fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P <0·001); paroxysmal Atrial Fibrillation with significantly elevated levels of plasma von Willebrand factor ( P =0·0067) and fibrinogen ( P =0·0001) but not soluble P-selectin ( P =0·472); and persistent Atrial Fibrillation with normal levels of fibrinogen, von Willebrand factor and soluble P-selectin when compared to healthy controls (all P =ns). Stepwise multiple regression analyses demonstrated that the presence of Atrial Fibrillation was an independent predictor of abnormal von Willebrand factor, fibrinogen and soluble P-selectin levels. Electrical cardioversion of the patients with persistent Atrial Fibrillation did not significantly alter levels of von Willebrand factor ( P =0·766), soluble P-selectin ( P =0·726) or fibrinogen ( P =0·50) despite maintenance of sinus rhythm and a significant return of left Atrial systolic function (as quantified by the presence of A wave on Doppler echocardiography) at 3 months. Conclusion There were significant differences in the prothrombotic state when patients with paroxysmal and Permanent Atrial Fibrillation are compared to matched patients with persistent Atrial Fibrillation or controls in sinus rhythm. Cardioversion of persistent Atrial Fibrillation did not significantly alter indices of hypercoagulability even after 3 months maintenance of sinus rhythm, despite the return of Atrial systole.