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

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J Am Coll Cardiol, 1994; 23:1535-1540
© 1994 by the American College of Cardiology Foundation

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

WJ Manning, DI Silverman, SE Katz, MF Riley, PC Come, RM Doherty, JT Munson, and PS Douglas

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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				R. Nieuwlaat, T. Dinh, S. B. Olsson, A. J. Camm, A. Capucci, R. G. Tieleman, G. Y.H. Lip, H. J.G.M. Crijns, and on behalf of the Euro Heart Survey Investigators Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation? Eur. Heart J., April 1, 2008; 29(7): 915 - 922. [Abstract] [Full Text] [PDF]

				A. Goette, A. Bukowska, U. Lendeckel, M. Erxleben, M. Hammwohner, D. Strugala, J. Pfeiffenberger, F.-W. Rohl, C. Huth, M. P.A. Ebert, et al. Angiotensin II Receptor Blockade Reduces Tachycardia-Induced Atrial Adhesion Molecule Expression Circulation, February 12, 2008; 117(6): 732 - 742. [Abstract] [Full Text] [PDF]

				H. Grubitzsch, A. Menes, D. Modersohn, and W. Konertz The Role of Atrial Remodeling for Ablation of Atrial Fibrillation Ann. Thorac. Surg., February 1, 2008; 85(2): 474 - 480. [Abstract] [Full Text] [PDF]

				A. C. Boyd, N. B. Schiller, D. L. Ross, and L. Thomas Segmental atrial contraction in patients restored to sinus rhythm after cardioversion for chronic atrial fibrillation: a colour Doppler tissue imaging study Eur J Echocardiogr, January 1, 2008; 9(1): 12 - 17. [Abstract] [Full Text] [PDF]

				A. M Anwar, M. L Geleijnse, O. I I Soliman, A. Nemes, and F. J t. Cate Left atrial Frank Starling law assessed by real-time, three-dimensional echocardiographic left atrial volume changes Heart, November 1, 2007; 93(11): 1393 - 1397. [Abstract] [Full Text] [PDF]

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				M. E.W. Hemels, T. Van Noord, H. J.G.M. Crijns, D. J. Van Veldhuisen, N. J.G.M. Veeger, H. A. Bosker, A. C.P. Wiesfeld, M. P. Van den Berg, A. V. Ranchor, and I. C. Van Gelder Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion for the Improvement of Rhythm Control for Persistent Atrial Fibrillation J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1001 - 1009. [Abstract] [Full Text] [PDF]

				Writing Committee 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: full text: 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 Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]

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				Y.-C. Wang, J.-L. Lin, J.-J. Hwang, M.-S. Lin, C.-D. Tseng, S. K. S. Huang, and L.-P. Lai Left Atrial Dysfunction in Patients With Atrial Fibrillation After Successful Rhythm Control for > 3 Months Chest, October 1, 2005; 128(4): 2551 - 2556. [Abstract] [Full Text] [PDF]

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				J. A. Chiladakis, A. Kalogeropoulos, N. Patsouras, and A. S. Manolis Ibutilide added to propafenone for the conversion of atrial fibrillation and atrial flutter J. Am. Coll. Cardiol., August 18, 2004; 44(4): 859 - 863. [Abstract] [Full Text] [PDF]

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