الفهرس 
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Abstract
A
trial fibrillation (AF) is the most common serious abnormal heart rhythm and, as of 2020, affects more than 33 million people worldwide. It is associated with substantial morbidity and mortality and is an important risk factor for stroke and systemic embolism, it increases mortality rate caused by stroke to five times.
Lone AF was meant to indicate AF in patients for whom subsequent investigations could not demonstrate heart disease. The prevalence of lone AF has fallen due to increasing knowledge about the pathophysiology of AF, which shows that in every patient a cause is present. However, subjects with lone AF provide a unique opportunity to eliminate the effects of associated conditions as many previous studies exploring inflammatory factors in AF have been confounded by concomitant medical illnesses.
Rates of AF progression were significantly lower with rhythm control than rate control. The success rate of cardioversion depends on various patient characteristics as well as on some technical variables. In stable patients, either pharmacological cardioversion or electrical cardioversion can be attempted; pharmacological cardioversion is less effective but does not require sedation.
AF is associated with increased levels of inflammatory markers and atrial biopsies in patients with AF have also confirmed the presence of inflammation.
Vitamin D is one of the important hormones involved in Ca homeostasis. Vitamin D deficiency is a global health problem. It is estimated that 30% to 50% of the worldwide population suffers from vitamin D deficiency. Vitamin D receptors (VDRs) have been found in cells throughout the body, such as cardiomyocytes and endothelial cells, suggesting this hormone has additional functions in the human body.
The association between vitamin D deficiency and AF has several potential pathophysiological mechanisms. Inflammation has a crucial role in the pathogenesis of AF. A meta-analysis found a vitamin D deficiency is associated with a 31% increased risk for AF.
Adequate concentrations of vitamin D can suppress the inflammatory response. The relationship between vitamin D deficiency and AF still requires more basic research support in the study of mechanisms.
Our study tested the impact of serum vitamin D deficiency on the success of cardioversion for patients presented with lone AF. This observational cross-sectional study included 50 patients (18-60 years old) who presented to Ain Shams university hospitals with lone atrial fibrillation with a structurally normal heart for cardioversion. All study patients were subjected to detailed medical history, complete clinical examination, 12 leads resting ECG, resting echocardiography, transesophageal echocardiography to rule out intracardiac thrombus and/or spontaneous echocardiographic contrast in both the left atrium and left atrial appendage, full laboratory investigations including serum vitamin D level on admission.
Cardioversion was assessed after then whether success or failure. Cardioversion success was defined as restoration of normal sinus rhythm and that the patient was discharged in sinus rhythm. Failure of cardioversion was defined as the failure of restoration to normal sinus rhythm after applying the cardioversion protocol that is being used in our cardiology department in Ain Shams University hospitals in the form of loading and maintenance doses of Intravenous (IV) Amiodarone, then if failed, application of biphasic synchronized direct current electrical cardioversion at 200 joules at anterior-lateral electrode positions for a once.
The failure rate of cardioversion was found to be higher in patients with vitamin D deficiency in comparison to patients with sufficient and insufficient vitamin D levels.
A larger randomized controlled study is needed to prove or disprove the results achieved in the current study.