title: Analysis of electrical and mechanical left atrial properties in patients with persistent atrial fibrillation.
abstract: The study of left atrial (LA) mechanical function during atrial fibrillation (AFib) can provide valuable information, particularly if such profiling is related to the cavity electrical substrate and conveys prognostic information. To assess if there is any relation between LA mechanical and electrical asynchrony and if such evaluation can be of interest in stratifying AFib patients. 50 patients with persistent AFib who underwent electrical cardioversion (CV) were evaluated with pre-CV atrial electrograms (AEGs). Electrical asynchrony was classified according to Wells' patterns of AEGs, ranging from most organized (I) to most dispersed (III) one. LA mechanical asynchrony was addressed by transthoracic 2D-speckle-tracking echo and quantified according to time-to-peak standard deviation (TP-SD) of wall strains and their peak values (PS) before CV, after 24 h, at 1 month. Pre-CV a linear, inverse relation between TP-SD and PS (p < 0.001) and a direct linear relation between TP-SD and Wells' classes (p = 0.04) were observed. With sinus rhythm TP-SD decreased (p = 0.023) and PS increased (p < 0.001), suggesting improved LA mechanical milieu. A multivariate analysis, testing the effects of baseline variables in predicting post-CV recurrence of AFib, revealed that amount of TP-SD variation pre/24 h post-CV was the only independent predictor at 6 months (p = 0.046). Speckle tracking-derived LA parameters can describe LA wall forces during AFib, categorizing the asynchronous mechanistic profile of AFib that correlates with the degree of the dispersed LA electrical activity. The amount of changes in LA mechanical asynchrony pre/post-CV seems to have prognostic relevance in predicting SR maintenance.
authors.affiliation: Department of Cardiology, Clinical Cardiology, Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Degiovanni
authors.forename: Miriam
authors.initials: M
authors.lastname: Bortnik
authors.forename: Gabriele
authors.initials: G
authors.lastname: Dell'Era
authors.forename: Virginia
authors.initials: V
authors.lastname: Bolzani
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bellomo
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016279:Atrial Function, Left; D001696:Biomechanical Phenomena; D018618:Echocardiography, Doppler, Color; D004554:Electric Countershock; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome