Atrial ejection force in patients with atrial fibrillation: Comparison between DC shock and pharmacological cardioversion

It is well known that the restoration of sinus rhythm is not always associa ted with the return of effective atrial contraction. Atrial ejection force (AEF) is a noninvasive Doppler derived parameter that measures the strength of the atrial contraction. The aim of the present study was to use pulsed- Doppler echocardiography to determine if different modalities of cardiovers ion influence the delay in the return of effective atrial contraction after cardioversion. DC shock and pharmacological therapy were compared. Sixty-e ight patients were randomly cardioverted, either using DC shock or i.v. pro cainamide. The patients who were restored to a sinus rhythm had a complete Doppler echocardiographic examination within 1 hour after the restoration, after 24 hours, after 1 month, and after 3 months. AEF was measured and com pared in the two groups of patients and within the same group. AEF was grea ter immediately and at 24 hours after cardioversion in patients who underwe nt pharmacological therapy compared to patients treated with DC shock (peak A wave, 60 +/- 9 vs 31 +/- 8 msec, P < 0.001; AEF 11.3 +/- 3 vs 5 +/- 2.9 dynes, P < 0.001). In both groups, AEF increases over time. In conclusion, AEF is a noninvasive parameter that can be easily measured after cardiovers ion and can give accurate information about the recovery of left atrial mec hanical function. This finding may have important implications for guiding the anticoagulant therapy after cardioversion.