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Updated: Aug 8, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Study of atrial function using echocardiographic automatic boundary detection following external or internal
Athanasios Kranidis1, Konstantinos Kappos, Ioannis Lekatsas
1A' Cardiology Department, "Evangelismos" General Hospital, Athens, Greece. kranidis@internet.gr
Insights
Atrial stunning after cardioversion for atrial fibrillation is not linked to cardioversion type. Higher energy during internal cardioversion correlates with greater left atrial dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Idiopathic atrial fibrillation management often involves cardioversion.
- Assessing post-cardioversion atrial function is crucial for understanding recovery.
- Echocardiography offers potential for objective assessment of atrial mechanics.
Purpose of the Study:
- To validate an automatic boundary detection (ABD) echocardiographic method for assessing atrial dysfunction.
- To evaluate the degree of atrial dysfunction following internal versus external cardioversion for idiopathic atrial fibrillation.
Main Methods:
- 31 patients with idiopathic atrial fibrillation underwent randomized internal or external cardioversion.
- Echocardiographic automatic boundary detection (ABD) assessed left and right atrial function (delta1-delta4 indices) within 24 hours post-cardioversion.
- Functional indices included total fractional change, passive change, contraction-induced change, and % atrial expansion.
Main Results:
- Successful cardioversion was achieved in 100% of patients.
- No significant differences in atrial functional indices (delta1-delta4) were observed between internal and external cardioversion groups.
- A negative correlation was found between left atrial function and delivered energy during internal cardioversion (p=0.01-0.04).
Conclusions:
- Atrial stunning post-cardioversion for idiopathic atrial fibrillation is independent of cardioversion modality.
- Increased energy delivered during internal cardioversion is associated with more pronounced left atrial dysfunction.
- The ABD method shows potential for quantifying atrial dysfunction after cardioversion.
Introduction:
The aim of this study was to evaluate the validity of an echocardiographic method of automatic boundary detection (ABD) in the assessment of the degree of atrial dysfunction in patients who had undergone external or internal cardioversion for idiopathic atrial fibrillation.
Methods:
The study population included 31 patients (mean age 48 +/- 6.5 years) with idiopathic atrial fibrillation. The patients were randomised into two groups: Group 1 (14 patients, 8 +/- 3.13 joules), where internal cardioversion was applied, and Group 2 (17 patients, 200-360 joules), where external cardioversion was used for restoration of sinus rhythm. During the following 24 hours the ABD method was used in both groups to assess the following functional indices for both the left and the right atrium: a) total fractional change of atrial area (delta1), b) passive change of atrial area (delta2), c) change of atrial area due to atrial contraction (delta3) and d) index of % atrial expansion (delta4).
Results:
All patients in both groups were successfully cardioverted (100%, p: NS). Post-cardioversion indices delta1-delta4 for both left and right atria did not differ between the 2 groups (p:NS). A negative correlation was found between left atrial function as assessed by ABD and the mean energy in joules delivered through the catheter in each patient for successful cardioversion (r = -0.55 to r = -0.67 and p = 0.04 to p = 0.01). However, no relevant correlations were found for the right atrium (p:NS).
Conclusions:
1) The atrial dysfunction which follows the cardioversion of idiopathic atrial fibrillation (atrial stunning) is not related to the type of cardioversion (internal or external). 2) The higher the amount of energy delivered during internal cardioversion, the greater the degree of left atrial dysfunction observed.
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