Clinical and echocardiographic features influencing recovery of atrial function after cardioversion of atrial fibrillation

Atrial mechanical dysfunction after cardioversion for atrial fibrillation h as been widely evaluated in recent years. Nevertheless, the influence of ma ny clinical and echocardiographic parameters is not yet understood. The aim of the present study was to evaluate the influence of clinical and echocar diographic parameters on the return of effective atrial contraction. A tota l of 109 patients were evaluated: 41 patients had spontaneous recovery of s inus rhythm and 68 patients were randomly treated using either direct-curre nt (DC) shock or intravenous procainamide. Elective cardioversion was accom plished pharmacologically in 23 patients (67%) and with DC shock in 29 pati ents (85%), Patients underwent a complete echocardiographic examination 1 h our after the restoration of sinus rhythm and after 1 and 7 days and 1 mont h. The following parameters were evaluated: patient age, cardiac disease, d uration and etiology of atrial fibrillation, mode of cardioversion, left ve ntricular diameters and function, and left atrial diameter and function ass essed as atrial election force. The relation between these variables and at rial ejection force was rested. Atrial election force wa; greater immediate ly and 24 hours after cardioversion in patients who had spontaneous recover y of sinus rt-rythm and in patients treated with drugs than in patients tre ated with DC shock. The mode of cardioversion was significantly associated with the recovery of atrial mechanical function by day 1 in univariate and multivariate analyses (odds ratio 0.14; 95% confidence interval 0.02 to 1.2 ), The other variable associated with the recovery of function was normal l eft atrial size (odds ratio 0.16; 95% confidence interval 0.12 to 1.6), In conclusion, atrial election force is a noninvasive parameter that can be ea sily measured and can provide accurate! information about the recovery of l eft atrial mechanical function, The recovery of atrial function was influen ced by the mode of cardioversion and the size of the left atrium. (C) 1998 by Excerpta Medica, Inc.