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Serial evaluation of left atrial dimension after cardioversion for atrial fibrillation and relation to atrial
A V Mattioli1, S Sansoni, G R Lucchi
1Department of Cardiology, University of Modena and Reggio Emilia, Italy. mattioli.annavittoria@unimo.it
Insights
Restoring normal heart rhythm (sinus rhythm) after atrial fibrillation (AF) reduces left atrial size. However, depressed atrial mechanical function after cardioversion is linked to persistent left atrial dilation.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Left atrial (LA) enlargement is a common finding in atrial fibrillation (AF).
- Understanding LA dimension changes post-cardioversion is crucial for assessing treatment outcomes.
- The relationship between LA size and atrial function requires further investigation.
Purpose of the Study:
- To evaluate changes in left atrial (LA) dimension following cardioversion for atrial fibrillation (AF).
- To explore the relationship between LA dimension and atrial mechanical function after rhythm restoration.
Main Methods:
- Compared echocardiographic LA size and volume in 171 patients undergoing spontaneous, drug-induced, or DC shock cardioversion for AF.
- Assessed LA passive and active emptying volumes to evaluate atrial function.
- Analyzed the correlation between LA size reduction and atrial ejection force.
Main Results:
- Left atrial (LA) size decreased post-cardioversion in all groups, most significantly with spontaneous rhythm restoration.
- Atrial stunning occurred in patients treated with DC shock or drugs.
- Reduced atrial mechanical function was associated with a persistence of LA dilation and altered LA volumes.
Conclusions:
- Cardioversion effectively reduces left atrial (LA) size, particularly with spontaneous rhythm restoration.
- Depressed atrial mechanical function post-cardioversion is linked to persistent LA dilation.
- Atrial ejection force influences the degree of LA size reduction after rhythm restoration.
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 cardio-version 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.