title: Left atrial asynchrony is a major predictor of 1-year recurrence of atrial fibrillation after electrical cardioversion.
abstract: BACKGROUND
  The level of atrial mechanical asynchrony may vary within the atrial fibrillation population and this may have pathophysiological relevance.
  
  
  OBJECTIVE
  We sought to verify whether the degree of left-atrial mechanical asynchrony associated with atrial fibrillation is a predictor of arrhythmia recurrence after restoration of sinus rhythm with electrical cardioversion.
  
  
  RESULTS
  Left atrial volume was calculated, whereas two-dimensional (2D) strain (speckle tracking technique) was used to estimate peak and standard deviation (SD) of time-to-peak of deformation of six segments arbitrarily identified along the perimeter of the cavity, imaged in apical four-chamber view. Left atrial mechanical asynchrony was quantified according to quartiles of time-to-peak SD assuming that larger values would identify higher grades of asynchrony. A total of 130 patients undergoing cardioversion for atrial fibrillation were prospectively enrolled. Time-to-peak SD was inversely related with peak strain (P < 0.001). No differences were observed among groups in terms of clinical, therapeutical and additional echocardiographic variables. At 1-year atrial fibrillation was observed in 53% of patients, with time-to-peak SD linearly related to atrial-fibrillation recurrence (P = 0.014). At multivariate analysis only time-to-peak SD (P = 0.032), but not atrial volume (P = 0.075), was identified as an independent predictor of fibrillation recurrence.
  
  
  CONCLUSIONS
  This is the first study showing that left atrial asynchrony, quantified as time-to-peak SD of regional atrial strains before electrical cardioversion, is a major independent predictor of fibrillation recurrence in patients back to sinus-rhythm postprocedure.
authors.affiliation: Cardiology Clinic and General Pathology, Eastern Piedmont University, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rondano
authors.forename: Gabriele
authors.initials: G
authors.lastname: Dell'Era
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Cristina
authors.initials: C
authors.lastname: Piccinino
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bellomo
authors.forename: Paolo N
authors.initials: PN
authors.lastname: Marino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016279:Atrial Function, Left; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D004554:Electric Countershock; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left