Changes in left and right atrial size after cardioversion of atrial fibrillation: role of mitral valve disease

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J Am Coll Cardiol, 1993; 22:1666-1672
© 1993 by the American College of Cardiology Foundation

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Changes in left and right atrial size after cardioversion of atrial fibrillation: role of mitral valve disease

AT Gosselink, HJ Crijns, HP Hamer, H Hillege, and KI Lie

Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands.

OBJECTIVES. The aim of this study was to examine the effect of cardioversion on left and right atrial volume in patients with chronic atrial fibrillation and to determine the influence of mitral valve disease on atrial size. BACKGROUND. Atrial enlargement is a common finding in atrial fibrillation and has been associated with an increased risk for embolic stroke. In addition, atrial enlargement may hamper long-term maintenance of sinus rhythm after cardioversion. METHODS. Forty-one patients with chronic atrial fibrillation (mean duration +/- SD, 45 +/- 62 months) underwent two-dimensional echocardiography before and 6 months after cardioversion to determine left and right atrial dimensions. Underlying heart disease was present in 26 patients: mitral valve disease in 12 (stenosis in 5, regurgitation in 5 and a combination in 2 patients) and other heart diseases in 14. Fifteen patients had lone atrial fibrillation. Patients with sustained sinus rhythm were compared with those who had a relapse of the arrhythmia 6 months after cardioversion. RESULTS. Six months after cardioversion, 28 patients still had sinus rhythm, whereas 13 patients had a relapse of the arrhythmia. In the 28 patients who had sinus rhythm after 6 months, left and right atrial volume decreased from a mean (+/- SD) 72.6 +/- 15.1 to 58.5 +/- 13.8 cm3 (-20%, p < 0.05) and from 68.7 +/- 14.6 to 58.6 +/- 11.6 cm3 (-14%, p < 0.05), respectively. Atrial dimensions also decreased significantly in the subgroup of patients with mitral valve disease. In contrast, no change in atrial size occurred in the 13 patients who had a relapse of atrial fibrillation. Left ventricular function did not change between the two echocardiographic studies, although New York Heart Association class improved in patients who had sinus rhythm after 6 months. CONCLUSIONS. Restoration of sinus rhythm reverts the process of left and right atrial enlargement in patients with chronic atrial fibrillation and mitral valve disease. Therefore, cardioversion may reduce the incidence of thromboembolic complications and prevent the arrhythmia from becoming refractory to medical therapy.

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				Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [Full Text] [PDF]

				W. P. Beukema, A. Elvan, H. T. Sie, A. R. Ramdat Misier, and H. J.J. Wellens Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size Circulation, October 4, 2005; 112(14): 2089 - 2095. [Abstract] [Full Text] [PDF]

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				L. Thomas, A. Boyd, S. P. Thomas, N. B. Schiller, and D. L. Ross Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation Eur. Heart J., November 1, 2003; 24(21): 1942 - 1951. [Abstract] [Full Text] [PDF]

				J. Langerveld, N. M. van Hemel, J. C. Kelder, J. M. P. G. Ernst, H. W. M. Plokker, and W. Jaarsma Long-term follow-up of cardiac rhythm after percutaneous mitral balloon valvotomy: Does atrial fibrillation persist? Europace, January 1, 2003; 5(1): 47 - 53. [Abstract] [PDF]

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				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]

				V. L.J.L. Thijssen, J. Ausma, and M. Borgers Structural remodelling during chronic atrial fibrillation: act of programmed cell survival Cardiovasc Res, October 1, 2001; 52(1): 14 - 24. [Abstract] [Full Text] [PDF]

				S. Yuda, S. Nakatani, Y. Kosakai, M. Yamagishi, and K. Miyatake Long-term follow-up of atrial contraction after the maze procedure in patients with mitral valve disease J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1622 - 1627. [Abstract] [Full Text] [PDF]

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				E. R. Jessurun, N. M. van Hemel, J. A. M. T. Defauw, M. A. M. Stofmeel, J. C. Kelder, A. Brutel de la Riviere, and J. M. P. G. Ernst Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation Circulation, April 4, 2000; 101(13): 1559 - 1567. [Abstract] [Full Text] [PDF]

				M. Pasic, M. Musci, H. Siniawski, O. Grauhan, B. Edelmann, T. Tedoriya, Y. Weng, and R. Hetzer THE COX MAZE III PROCEDURE: PARALLEL NORMALIZATION OF SINUS NODE DYSFUNCTION, IMPROVEMENT OF ATRIAL FUNCTION, AND RECOVERY OF THE CARDIAC AUTONOMIC NERVOUS SYSTEM J. Thorac. Cardiovasc. Surg., August 1, 1999; 118(2): 287 - 296. [Abstract] [Full Text] [PDF]

				D. I. Silverman and W. J. Manning Role of Echocardiography in Patients Undergoing Elective Cardioversion of Atrial Fibrillation Circulation, August 4, 1998; 98(5): 479 - 486. [Abstract] [Full Text] [PDF]

				C. Rostagno, G. Olivo, M. Comeglio, G. Bertini, G. F. Gensini, and G. Galanti Left Atrial Size Changes in Patients with Paroxysmal Lone Atrial Fibrillation: An Echocardiographic Follow-up Angiology, August 1, 1996; 47(8): 797 - 801. [Abstract] [PDF]