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Atrial ejection force in patients with atrial fibrillation: comparison between DC shock and pharmacological
A V Mattioli1, A Castelli, E Bastia
1Department of Cardiology, University of Modena, Italy.
Insights
Pharmacological cardioversion restores atrial contraction force faster than DC shock. Atrial ejection force (AEF) recovery is quicker with medications, aiding decisions on anticoagulant therapy post-cardioversion.
Area of Science:
- Cardiology
- Medical Imaging
- Pharmacology
Background:
- Restoring sinus rhythm doesn't always restore effective atrial contraction.
- Atrial ejection force (AEF) quantifies atrial contraction strength noninvasively.
Purpose of the Study:
- To compare DC shock and pharmacological therapy for cardioversion.
- To assess the influence of cardioversion modality on the return of atrial contraction.
Main Methods:
- Sixty-eight patients randomly received DC shock or IV procainamide.
- Pulsed-Doppler echocardiography measured AEF at baseline, 24 hours, 1 month, and 3 months post-cardioversion.
Main Results:
- Pharmacological therapy showed significantly higher AEF than DC shock immediately and at 24 hours.
- AEF increased over time in both groups, indicating recovery of atrial function.
Conclusions:
- AEF is a valuable noninvasive tool for assessing left atrial mechanical function post-cardioversion.
- Findings may guide anticoagulant therapy decisions after restoring sinus rhythm.
Abstract:
It is well known that the restoration of sinus rhythm is not always associated with the return of effective atrial contraction. Atrial ejection force (AEF) is a noninvasive Doppler derived parameter that measures the strength of the atrial contraction. The aim of the present study was to use pulsed-Doppler echocardiography to determine if different modalities of cardioversion influence the delay in the return of effective atrial contraction after cardioversion. DC shock and pharmacological therapy were compared. Sixty-eight patients were randomly cardioverted, either using DC shock or i.v. procainamide. The patients who were restored to a sinus rhythm had a complete Doppler echocardiographic examination within 1 hour after the restoration, after 24 hours, after 1 month, and after 3 months. AEF was measured and compared in the two groups of patients and within the same group. AEF was greater immediately and at 24 hours after cardioversion in patients who underwent pharmacological therapy compared to patients treated with DC shock (peak A wave, 60 +/- 9 vs 31 +/- 8 msec, P < 0.001; AEF 11.3 +/- 3 vs 5 +/- 2.9 dynes, P < 0.001). In both groups, AEF increases over time. In conclusion, AEF is a noninvasive parameter that can be easily measured after cardioversion and can give accurate information about the recovery of left atrial mechanical function. This finding may have important implications for guiding the anticoagulant therapy after cardioversion.