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Hemodynamics and echocardiograms before and after cardioversion of atrial fibrillation to normal sinus rhythm
Insights
Cardioversion for atrial fibrillation improved cardiac function shortly after the procedure. However, left atrial size and echocardiographic measures did not predict long-term success in maintaining normal sinus rhythm.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity.
- Cardioversion aims to restore normal sinus rhythm (NSR) but recurrence rates can be high.
- Understanding factors influencing long-term rhythm stability post-cardioversion is crucial.
Purpose of the Study:
- To evaluate the immediate hemodynamic and echocardiographic effects of cardioversion for atrial fibrillation.
- To identify predictors of sustained normal sinus rhythm after cardioversion.
Main Methods:
- Hemodynamic and echocardiographic measurements were performed in 15 patients before and at several time points after cardioversion.
- Patients were followed for up to nine months to assess rhythm status.
- Statistical analysis was used to correlate baseline and post-procedure parameters with rhythm persistence.
Main Results:
- Within five hours post-cardioversion, significant improvements were observed in cardiac index, stroke index, and stroke work index.
- No significant changes were noted in heart rate, pulmonary capillary wedge pressure, or left ventricular dimensions (LAD, LVEDD, LVESD).
- Sixty-seven percent of patients (10/15) maintained normal sinus rhythm at follow-up; however, left atrial size, hemodynamic changes, ventricular dimensions, or mitral valve A-wave characteristics did not correlate with rhythm persistence.
Conclusions:
- Cardioversion of atrial fibrillation leads to prompt improvements in cardiac hemodynamics.
- Predictors of long-term normal sinus rhythm maintenance remain elusive, suggesting other factors beyond echocardiographic and hemodynamic parameters are involved.
Abstract:
Hemodynamic and echocardiographic measurements were obtained in 15 patients prior to cardioversion and immediately, one, three, and five hours after cardioversion of atrial fibrillation to normal sinus rhythm. At five hours after cardioversion, there was improvement in cardiac index (P less than 0.005), in stroke index (P less than 0.005), and in stroke work index (P less than 0.025), but no significant change in heart rate, mean pulmonary capillary wedge pressure, left atrial dimemsions (LAD), left ventricular end-diastolic dimensions (LVEDD), or left ventricular end-systolic dimension (LVESD). At follow-up one week to nine months after cardioversion, 10 of the 15 patients (67 percent) remained in normal sinus rhythm. Neither the size of the left atrium, changes in hemodynamics, LAD, LVEDD, or LVESD, nor the presence or amplitude of the A-wave on the mitral valve echogram correlated with the persistence or normal sinus rhythm.