ATRIAL AND VENTRICULAR-FUNCTION AFTER CARDIOVERSION OF ATRIAL-FIBRILLATION

Objective-Previous studies on atrial recovery after cardioversion of a trial fibrillation have not taken into account new knowledge about the pathophysiology of transmitral and transtricuspid flow velocity patte rns. It is possible to shed further light on this problem if atriovent ricular inflow velocity, venous filling pattern, and atrioventricular annulus motion are recorded and interpreted together. Design-Prospecti ve examinations of mitral and tricuspid transvalvar flow velocities, s uperior caval and pulmonary venous filling, and mitral and tricuspid a nnulus motion were recorded using Doppler echocardiography. Examinatio ns were performed before and 24 hours, 1 month, and 20 months after ca rdioversion. Setting-Tertiary referral centre for cardiac disease with facilities for invasive and non-invasive investigation. Patients-16 p atients undergoing cardioversion of atrial fibrillation in whom sinus rhythm had persisted for 24 hours or more. Results-Before conversion t here was no identifiable A wave in transvalvar flow recordings. The to tal motion of the tricuspid and mitral annulus was subnormal and there was no identifiable atrial component. Venous flow patterns in general showed a low systolic velocity. After conversion, A waves and atrial components were seen in all patients and increased significantly (P<0. 01) with time. There was a similar time course for the amplitude of an nulus atrial components, an increased systolic component of venous inf low, an increased A wave velocity, and a decreased EIA ratio of the tr ansvalvar velocity curves. The ventricular component of annulus motion was unchanged. Changes in general occurred earlier on the right side than the left. Conclusions-This study indicates that, in addition to t he previously known electromechanical dissociation of atrial recovery that exists after cardioversion of atrial fibrillation, there may also be a transient deterioration of ventricular function modulating the t ransvalvar inflow velocity recordings. Function on the right side gene rally becomes normal earlier than on the left. Integration of informat ion from transvalvar inflow curves, annulus motion, and venous filling patterns gives additional insight into cardiac function.