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Time-course of recovery of atrial contraction after cardioversion of chronic atrial fibrillation

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Summary

We aimed to study the time-course of recovery of atrial contraction after cardioversion of chronic atrial fibrillation (duration of more than 3 months) to sinus rhythm. Using M-mode, two-dimensional and pulsed Doppler echocardiography, we determined left atrial (LA) and ventricular (LV) dimensions, peak velocities, and velocity-time integrals of early and atrial filling velocity-time profiles in both LV and right ventricular (RV) inflows (peak E and peak A, Ea and Aa). Results of the LA and LV functions in seven elderly patients (an initial study group) were as follows. The extent of the LA dimensional reduction resulting from atrial contraction was significantly increased up to 5–8 weeks compared with values 0–1 day after cardioversion [from 1.3 ± 0.8(mean ± SD) mm to 3.9 ± 1.1,P < 0.01]. In conjunction with the progressive increase in peak A, the ratio of peak E to peak A (peak E/A) was significantly decreased and reached a plateau at 5–8 weeks (from 1.93 ± 0.59 to 0.67 ± 0.11,P < 0.01). LV fractional shortening was increased significantly 5–8 weeks after cardioversion (from 0.20 ± 0.06 to 0.29 ± 0.05,P < 0.01). Since a large part of the improvement in LA contraction was expected to occur in an early stage after cardioversion, we studied eight additional patients more frequently in the early stage (an additional study group). Furthermore, we studied the time course of LA and right atrial (RA) contractions. The peak A in LV inflow velocity was significantly and progressively increased up to 1–3 weeks compared with values within 24 h after cardioversion (from 23.1 ± 7.6 cm/s to 40.6 ± 9.9,P < 0.01). The peak A in RV inflow velocity was similarly increased (from 17.6 ± 7.2 cm/s to 28.1 ± 5.4,P < 0.01). Peak E/A in LV inflow velocity was significantly and progressively decreased at 1–3 weeks, and this was also the case with peak E/A in RV inflow velocity. We conclude that it takes several weeks for each of the left and right atria to restore full strength after cardioversion of chronic atrial fibrillation.

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References

  1. Shapiro EP, Effron MB, Lima S, Ouyang P, Siu CO, Bush D (1988) Transient atrial dysfunction after conversion of chronic atrial fibrillation to sinus rhythm. Am J Cardiol 62:1202–1207

    Google Scholar 

  2. Manning WJ, Leeman DE, Gotch PJ, Come PC (1989) Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation. J Am Coll Cardiol 13:617–623

    Google Scholar 

  3. Miyatake K, Okamoto M, Kinoshita N, Owa M, Nakasone I, Sakakibara H, Nimura Y (1984) Augmentation of atrial contribution to left ventricular inflow with aging as assessed by intracardiac Doppler flowmetry. Am J Cardiol 53:586–589

    Google Scholar 

  4. Resnekov L, McDonald L (1965) Pulmonary edema following treatment of arrhythmias by direct-current shock. Lancet I:506–508

    Google Scholar 

  5. Resnekov L, McDonald L (1967) Complications in 220 patients with cardiac dysrhythmias treated by phased direct current shock, and indications for electroconversion. Br Heart J 29:926–936

    Google Scholar 

  6. Wallenstein S, Zucker CL, Fleiss JL (1980) Some statistical methods useful in circulation research. Circ Res 47:1–9

    Google Scholar 

  7. Dethy M, Chassat C, Roy D, Mercier L-A (1988) Doppler echocardiographic predictors of recurrence of atrial fibrillation after cardioversion. Am J Cardiol 62:723–726

    Google Scholar 

  8. Morris JJ Jr, Peter RH, McIntosh HD (1966) Electrical conversion of atrial fibrillation: Immediate and long-term results and selection of patients. Ann Intern Med 65:216–231

    Google Scholar 

  9. Mancini GBJ, Goldberger AL (1982) Cardioversion of atrial fibrillation: Consideration of embolization, anticoagulation, prophylactic pacemaker, and long-term success. Am Heart J 104:617–621

    Google Scholar 

  10. Probst P, Goldschlager N, Selzer A (1973) Left atrial size and atrial fibrillation in mitral stenosis: Factors influencing their relationship. Circulation 48:1282–1287

    Google Scholar 

  11. Henry WL, Morganroth J, Pearlman AS, Clark CE, Redwood DR, Itscoitz SB, Epstein SE (1976) Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53:273–279

    Google Scholar 

  12. Flugelman MY, Hasin Y, Katznelson N, Kriwisky M, Shefer A, Gotsman MS (1984) Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis. Am J Cardiol 54:617–619

    Google Scholar 

  13. Brodsky MA, Allen BJ, Capparelli EV, Luckett CR, Morton R, Henry WL (1989) Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation. Am J Cardiol 63:1065–1068

    Google Scholar 

  14. Dittrich HC, Erickson JS, Schneiderman T, Blacky AR, Savides T, Nicod PH (1989) Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 63:193–197

    Google Scholar 

  15. DeMaria AN, Lies JE, King JF, Miller RR, Amsterdam EA, Mason DT (1975) Echographic assessment of atrial transport, mitral movement, and ventricular performance following electroversion of supraventricular arrhythmias. Circulation 51:273–282

    Google Scholar 

  16. Orlando JR, van Herick R, Aronow WS, Olson HG (1979) Hemodynamics and echocardiograms before and after cardioversion of atrial fibrillation to normal sinus rhythm. Chest 76:521–526

    Google Scholar 

  17. O'Neill PG, Puleo PR, Bolli R, Rokey R (1990) Return of atrial mechanical function following electrical conversion of atrial dysrhythmias. Am Heart J 120:353–359

    Google Scholar 

  18. Ochi H, Izumi S, Murakami R, Shimada T, Morioka S, Moriyama K (1991) Superior vena cava flow and tricuspid anular motion after cardioversion of atrial fibrillation, and role of right atrial relaxation on systolic venous return. Am J Cardiol 68:1335–1339

    Google Scholar 

  19. Alam M, Thorstrand C (1992) Left ventricular function in patients with atrial fibrillation before and after cardioversion. Am J Cardiol 69:694–696

    Google Scholar 

  20. Bailey GWH, Braniff BA, Hancock EW, Cohn KE (1968) Relation of left atrial pathology to atrial fibrillation in mitral valvular disease. Ann Intern Med 69:13–20

    Google Scholar 

  21. Kusuoka H, Porterfield JK, Weisman HF, Weisfeldt ML, Marban E (1987) Pathophysiology and pathogenesis of stunned myocardium. J Clin Invest 79:950–961

    Google Scholar 

  22. Hoffman BF (1984) Cellular and tissue responses to recurrent ventricular tachycardia and fibrillation. PACE 7:489–492

    Google Scholar 

  23. Ormiston JA, Shah PM, Tei C, Wong M (1981) Size and motion of the mitral valve annulus in man: I. A twodimensional echocardiographic method and findings in normal subjects. Circulation 64:113–120

    Google Scholar 

  24. Halmos PB (1966) Direct current conversion of atrial fibrillation. Br Heart J 28:302–308

    Google Scholar 

  25. Iwase M, Sotobata I, Yokota M, Takagi S, Jing HX, Kawai N, Hayashi H, Murase M (1986) Evaluation by pulsed Doppler echocardiography of the atrial contribution to left ventricular filling in patients with DDD pacemakers. Am J Cardiol 58:104–109

    Google Scholar 

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Authors and Affiliations

  1. Second Department of Internal Medicine, Gifu University School of Medicine, 40 Tsukasa-machi, 500, Gifu City, Gifu, Japan

    Hiroshi Miwa, Michio Arakawa, Kensaku Kagawa, Toshiyuki Noda, Kazuhiko Nishigaki, Yoshimi Ito, Tomoo Kawada & Senri Hirakawa

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  1. Hiroshi Miwa
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  2. Michio Arakawa
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  3. Kensaku Kagawa
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  4. Toshiyuki Noda
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  5. Kazuhiko Nishigaki
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  6. Yoshimi Ito
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  7. Tomoo Kawada
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  8. Senri Hirakawa
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Miwa, H., Arakawa, M., Kagawa, K. et al. Time-course of recovery of atrial contraction after cardioversion of chronic atrial fibrillation. Heart Vessels 8, 98–106 (1993). https://doi.org/10.1007/BF01744390

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  • DOI: https://doi.org/10.1007/BF01744390

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