The relation between transmitral early filling wave deceleration time and the recovery of atrial contractility after electrical cardioversion of atrial fibrillation

Background: Electrical cardioversion of atrial fibrillation (AF) to sinus r hythm is associated with transient left atrial dysfunction and this phenome non may lead to thrombus formation and embolic stroke. Delay of atrial mech anical function recovery may be related to ventricular diastolic function. Objective: This study examined the effects of left ventricular diastolic fu nction as well as the multiple clinical factors on the recovery of atrial s ystolic function after cardioversion for atrial fibrillation. Methods: A to tal of 44 patients (28 male, 16 female, 61 +/- 18 years) with chronic AF (g reater than or equal to 1 month) underwent electrical cardioversion. Decele ration time of early filling wave (pre-CV EDT) on transmitral inflow obtain ed by using Doppler echocardiography before cardioversion and serial transm itral inflow Doppler variables were recorded through a 1 week study period in all patients. Various clinical (age, gender, the duration of AF) and ech ocardiographic variables (pre-CV EDT, left atrial dimension, left ventricul ar ejection fraction) were tested for an association with peak atrial filli ng wave velocity (VA) on day 1, 3 and 7 after cardioversion. Results: EDT m easured before cardioversion had a strong linear correlation with peak VA o n every echocardiographic evaluation after cardioversion (Regression coeffi cient (R) = 0.69, P < 0.001; R = 0.78, P < 0.001 and R = 0.83, P < 0.001, o n day 1, day 3 and day 7, respectively). The effect of left ventricular eje ction fraction on peak VA was weaker than those of EDT. The duration of AF showed an inverse association with the recovery of atrial function, but thi s lost on multivariate analysis. None of the other parameters significantly correlated with peak VA after cardioversion. Conclusion: The recovery of a trial mechanical function after cardioversion, as assessed by peak VA on tr ansthoracic Doppler echocardiography is mainly associated with the left ven tricular diastolic function as treasured by EDT, whereas the left ventricul ar systolic function relatively a small effect on this outcome. The duratio n of AF does not have any association with peak VA, possibly if it is chron ic. 2001 Elsevier Science Ireland Ltd. All rights reserved.