Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation

Charles A. Dana Research Institute, Boston, Massachusetts.

OBJECTIVES. We hypothesized that the time course of the recovery of atrial systolic function may be related to the duration of atrial fibrillation before cardioversion and sought to study noninvasively the recovery of left atrial mechanical function utilizing serial transthoracic Doppler studies. BACKGROUND. Recovery of atrial mechanical function may be delayed for several weeks after successful cardioversion of atrial fibrillation to sinus rhythm. METHODS. After successful cardioversion, 60 patients with atrial fibrillation of brief (< or = 2 weeks, 17 patients), moderate (> 2 to 6 weeks, 22 patients) or prolonged (> 6 weeks, 21 patients) duration were followed up with serial transmitral pulsed Doppler echocardiography immediately (60 patients) and at 24 h (45 patients), 1 week (41 patients), 1 month (31 patients) and > 3 months (30 patients) after cardioversion. RESULTS. Atrial mechanical function is greater immediately and at 24 h and 1 week after cardioversion in patients with "brief" compared with "prolonged" atrial fibrillation. In all groups, atrial mechanical function increases over time, ultimately achieving similar levels. Full recovery of atrial mechanical function, however, is achieved within 24 h in patients with brief atrial fibrillation, within 1 week in patients with moderate-duration atrial fibrillation and within 1 month in patients with prolonged atrial fibrillation. CONCLUSIONS. Recovery of left atrial mechanical function is related to the duration of atrial fibrillation before cardioversion. These findings have important implications for assessing the early hemodynamic benefit of successful cardioversion.

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				A Wakai and J O O'Neill Emergency management of atrial fibrillation Postgrad. Med. J., June 1, 2003; 79(932): 313 - 319. [Abstract] [Full Text] [PDF]

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				F. Gentile, A. Elhendy, B. K. Khandheria, J. B. Seward, C. M. Lohse, W.-K. Shen, K. R. Bailey, S. C. Montgomery, K. N. Burger, and A. J. Tajik Safety of Electrical Cardioversion in Patients With Atrial Fibrillation Mayo Clin. Proc., September 1, 2002; 77(9): 897 - 904. [Abstract] [PDF]

				P. Jourdain, M. Bellorini, F. Funck, Y. Fulla, N. Guillard, J. Loiret, B. Thebault, N. Sadeg, and M. Desnos Short-term effects of sinus rhythm restoration in patients with lone atrial fibrillation: a hormonal study Eur J Heart Fail, June 1, 2002; 4(3): 263 - 267. [Abstract] [Full Text] [PDF]

				M. Allessie, J. Ausma, and U. Schotten Electrical, contractile and structural remodeling during atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 230 - 246. [Abstract] [Full Text] [PDF]

				B. J.J.M. Brundel, R. H. Henning, H. H. Kampinga, I. C. Van Gelder, and H. J.G.M. Crijns Molecular mechanisms of remodeling in human atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 315 - 324. [Abstract] [Full Text] [PDF]

				B. J.J.M Brundel, J. Ausma, I. C van Gelder, J. J.L Van Der Want, W. H van Gilst, H. J.G.M Crijns, and R. H Henning Activation of proteolysis by calpains and structural changes in human paroxysmal and persistent atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 380 - 389. [Abstract] [Full Text] [PDF]

				V. L.J.L Thijssen, H. M.W van der Velden, E. P van Ankeren, J. Ausma, M. A Allessie, M. Borgers, G. J.J.M van Eys, and H. J Jongsma Analysis of altered gene expression during sustained atrial fibrillation in the goat Cardiovasc Res, May 1, 2002; 54(2): 427 - 437. [Abstract] [Full Text] [PDF]

				M. I. Dunn and J. L. Marcum Atrial Mechanical Performance Following Internal and External Cardioversion of Atrial Fibrillation : Its Relationship to Peripheral Embolization and Acute Cerebrovascular Accident Chest, January 1, 2002; 121 (1): 1 - 3. [Full Text] [PDF]

				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 Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]

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				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]

				N.M. Al-Saady and M. Sopher Prothrombotic markers in atrial fibrillation: what is new? Eur. Heart J., September 2, 2001; 22(18): 1635 - 1639. [PDF]

				F.L Li-Saw-Hee, A.D Blann, D Gurney, and G.Y.H Lip Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and permanent atrial fibrillation. Effects of cardioversion and return of left atrial function Eur. Heart J., September 2, 2001; 22(18): 1741 - 1747. [Abstract] [PDF]

				P. B. Sparks and J. M. Kalman Is atrial flutter a risk factor for stroke? J. Am. Coll. Cardiol., September 1, 2001; 38(3): 785 - 788. [Full Text] [PDF]

				R. H. Falk Atrial Fibrillation N. Engl. J. Med., April 5, 2001; 344(14): 1067 - 1078. [Full Text] [PDF]

				C Pandozi and M Santini Update on atrial remodelling owing to rate. Does atrial fibrillation always 'beget' atrial fibrillation? Eur. Heart J., April 1, 2001; 22(7): 541 - 553. [PDF]

				U. Schotten, J. Ausma, C. Stellbrink, I. Sabatschus, M. Vogel, D. Frechen, F. Schoendube, P. Hanrath, and M. A. Allessie Cellular Mechanisms of Depressed Atrial Contractility in Patients With Chronic Atrial Fibrillation Circulation, February 6, 2001; 103(5): 691 - 698. [Abstract] [Full Text] [PDF]

				Y. Ishii, T. Nitta, M. Fujii, H. Ogasawara, H. Iwaki, N. Ohkubo, and S. Tanaka Serial change in the atrial transport function after the radial incision approach Ann. Thorac. Surg., February 1, 2001; 71(2): 572 - 576. [Abstract] [Full Text] [PDF]

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				C. Stellbrink and P. Hanrath The optimal management of cardioversion of atrial fibrillation of flutter: still a 'stunning' problem Eur. Heart J., May 2, 2000; 21(10): 795 - 798. [PDF]

				A Roijer, J Eskilsson, and B Olsson Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion Eur. Heart J., May 2, 2000; 21(10): 837 - 847. [Abstract] [PDF]

				G. Corrado, M. Santarone, S. Beretta, G. Tadeo, L.M. Tagliagambe, G. Foglia-Manzillo, M. Spata, E. Miglierina, F. Acquati, and M. Santarone Early cardioversion of atrial fibrillation and atrial flutter guided by transoesophageal echocardiography: A single centre 8{middle dot}5-year experience Europace, January 1, 2000; 2(2): 119 - 126. [Abstract] [PDF]

				N M Al-Saady, O A Obel, and A J Camm Left atrial appendage: structure, function, and role in thromboembolism Heart, November 1, 1999; 82(5): 547 - 554. [Abstract] [Full Text]

				M J Weigner, S E Katz, P S Douglas, and W J Manning Left atrial appendage anatomy and function: short term response to sustained atrial fibrillation Heart, November 1, 1999; 82(5): 555 - 558. [Abstract] [Full Text]

				W. J. Manning, D. I. Silverman, H. Oral, and F. Morady Cardioversion of Atrial Fibrillation N. Engl. J. Med., October 21, 1999; 341(17): 1313 - 1313. [Full Text]

				P. B. Sparks, H. G. Mond, J. K. Vohra, A. G. Yapanis, L. E. Grigg, and J. M. Kalman Mechanical Remodeling of the Left Atrium After Loss of Atrioventricular Synchrony : A Long-Term Study in Humans Circulation, October 19, 1999; 100(16): 1714 - 1721. [Abstract] [Full Text] [PDF]

				E. G. Daoud, P. Marcovitz, B. P. Knight, R. Goyal, K. C. Man, S. A. Strickberger, W. F. Armstrong, and F. Morady Short-Term Effect of Atrial Fibrillation on Atrial Contractile Function in Humans Circulation, June 15, 1999; 99(23): 3024 - 3027. [Abstract] [Full Text] [PDF]

				B. J.J.M. Brundel, I. C. Van Gelder, R. H. Henning, A. E. Tuinenburg, L. E. Deelman, R. G. Tieleman, J. G. Grandjean, W. H. Van Gilst, and H. J.G.M. Crijns Gene expression of proteins influencing the calcium homeostasis in patients with persistent and paroxysmal atrial fibrillation Cardiovasc Res, May 1, 1999; 42(2): 443 - 454. [Abstract] [Full Text] [PDF]

				P. B. Sparks, S. Jayaprakash, H. G. Mond, J. K. Vohra, L. E. Grigg, and J. M. Kalman Left atrial mechanical function after brief duration atrial fibrillation J. Am. Coll. Cardiol., February 1, 1999; 33(2): 342 - 349. [Abstract] [Full Text] [PDF]

				C.J. Meurling, M.P. Ingemansson, A. Roijer, J. Carlson, C.J. Lindholm, B. Smideberg, L. Sorno, M. Stridh, and S.B. Olsson Attenuation of electrical remodelling in chronic atrial fibrillation following oral treatment with verapamil Europace, January 1, 1999; 1(4): 234 - 241. [Abstract] [PDF]

				E. K. Louie, D. Liu, S. I. Reynertson, H. S. Loeb, T. L. McKiernan, P. J. Scanlon, and R. J. Hariman "Stunning" of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm: Demonstration by transesophageal Doppler techniques in a canine model J. Am. Coll. Cardiol., December 1, 1998; 32(7): 2081 - 2086. [Abstract] [Full Text] [PDF]

				H. Sun, R. Gaspo, N. Leblanc, and S. Nattel Cellular Mechanisms of Atrial Contractile Dysfunction Caused by Sustained Atrial Tachycardia Circulation, August 18, 1998; 98(7): 719 - 727. [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]

				P. B. Sparks, S. Jayaprakash, J. K. Vohra, H. G. Mond, A. G. Yapanis, L. E. Grigg, and J. M. Kalman Left atrial "stunning" following radiofrequency catheter ablation of chronic atrial flutter J. Am. Coll. Cardiol., August 1, 1998; 32(2): 468 - 475. [Abstract] [Full Text] [PDF]

				J. F. Obadia, M. E. Farra, O. H. Bastien, M. Lievre, Y. Martelloni, and J. F. Chassignolle OUTCOME OF ATRIAL FIBRILLATION AFTER MITRAL VALVE REPAIR J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 179 - 185. [Abstract] [Full Text]

				C. B. Upshaw Jr Hemodynamic Changes After Cardioversion of Chronic Atrial Fibrillation Arch Intern Med, May 26, 1997; 157(10): 1070 - 1076. [Abstract] [PDF]

				HOW QUICKLY DOES THE ATRIUM RECOVER FROM CARDIOVERSION? Journal Watch (General), June 17, 1994; 1994(617): 4 - 4. [Full Text]