Doppler sonographic evaluation of left atrial function after cardioversionof atrial fibrillation

Restoration of sinus rhythm is not always followed by immediate return of e ffective atrial contraction. Left atrial mechanical function can be assesse d by Doppler echocardiography; in the present study we measured the atrial ejection force, which is a noninvasive Doppler-derived parameter that measu res the strength of atrial contraction. The aim of the present study was to evaluate the influence of clinical and echocardiographic parameters: durat ion and cause of atrial fibrillation, different modality of cardioversion, and left atrial size with respect to the delay in the return of effective a trial contraction after cardioversion. Seventy patients were randomly chose n to undergo cardioversion by either direct current shock or intravenously administered procainamide hydrochloride. The 52 patients who had sinus rhyt hm restored underwent a complete Doppler echocardiographic examination 1 h after the restoration of sinus rhythm and after 1 day, 7 days, and 1 month. The relation between clinical variables and atrial ejection force was test ed. Atrial ejection force was greater immediately and 24 h after cardiovers ion in patients who underwent pharmacologic therapy compared to patients tr eated with direct current shock (11.3 +/- 3 versus 5 +/- 2.9 dynes; P < 0.0 01). in both groups atrial ejection force increased over time. The mode of cardioversion was significantly associated with recovery of left atrial mec hanical function by day 1 in univariate and multivariate analysis (odds rat io, 0.14; 95% confidence interval, 0.02-1.2). The other variable associated with the delay in the recovery of atrial function was a dilated left atriu m (odds ratio, 0.16; 95%; confidence interval, 0.12-1.6). Atrial ejection f orce is a noninvasive parameter that can be easily measured after cardiover sion and gives accurate information about the recovery of left atrial mecha nical function. The recovery of left atrial function was influenced by the mode of cardioversion and left atrial size.