Serial evaluation of left atrial dimension after cardioversion for atrial fibrillation and relation to atrial function

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Abstract

The size of the left atrium is usually increased during atrial fibrillation (AF). The aim of the present study was to evaluate changes in left atrial (LA) dimension after cardioversion for AF, and the relation between LA dimension and atrial function. The initial study population included 171 consecutive patients. Patients who had spontaneous cardioversion to sinus rhythm (56 patients) were compared with patients who had random cardioversion with drugs (50 patients) or direct-current (DC) shock (50 patients). Echocardiographic evaluations included LA size and volume. LA passive and active emptying volumes were calculated, and LA function was assessed. Atrial stunning was observed in 18 patients reverted with DC shock and in 7 patients reverted with drugs. The left atrium was dilated in all patients during AF (48 ± 5 mm). The size of the left atrium decreased after restoration of sinus rhythm in all patients with spontaneous reversion to sinus rhythm, in 73% of patients reverted with drugs, and in 50% of patients reverted with DC shock. The comparison between patients with a normal mechanical atrial function and patients with reduced atrial function showed that a higher atrial ejection force was associated with a more marked reduction in LA size after restoration of sinus rhythm. A relation between LA volumes and atrial ejection force was observed in the group of patients with depressed atrial mechanical function (r = −0.78; p <0.001). The active emptying fraction was lower, although not significantly, in this group, whereas the conduit volume was increased. Thus, a depressed atrial mechanical function after cardioversion for AF was associated with a persistence of LA dilation.

Section snippets

Study population

Hemodynamically stable patients referred for cardioversion for nonrheumatic AF between September 1997 and December 1998 were considered for inclusion in this study. The study group included 171 consecutive patients; 15 were excluded because they did not meet the inclusion criteria. Fifty-six patients had spontaneous recovery of sinus rhythm and the remaining 100 patients were randomized to receive intravenous procainamide or electrical cardioversion. Patients were excluded from the study if

Results

Before intravenous therapy, 56 patients had spontaneous conversion to sinus rhythm (group A). Of the remaining 100 patients, 50 patients were randomized to DC shock and 50 were randomized to receive procainamide. Elective cardioversion for AF was accomplished pharmacologically in 32 patients (64%; group B) and with DC cardioversion in 48 patients (96%; group C). The 3 groups were similar with respect to age and concomitant diseases; the duration of AF was significantly shorter in the group of

Discussion

The present study evaluated the recovery of atrial mechanical function after cardioversion for AF and its relation with LA volumes and function. One conclusion that emerged from the present study was that LA mechanical function was impaired after atrial defibrillation, and recovery was delayed in patients who underwent DC shock compared with patients who spontaneously reverted or who underwent pharmacologic cardioversion. These data confirm previous results from other studies.10, 14 Recovery

References (24)

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