title: Left atrial function assessed by Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Paroxysmal atrial fibrillation (PaAF) may present as a single self-terminating episode of atrial fibrillation (AF) or a more persistent form after sinus conversion. We investigated predictors of recurrence in patients with PaAF.
  
  
  OBJECTIVE
  Left atrial function would be an useful parameter for predicting PaAF recurrence.
  
  
  METHODS
  The study population included 228 PaAF patients (131 males, age 64±14 years) who underwent transthoracic echocardiography immediately after spontaneous sinus conversion at initial AF diagnosis. We followed the study patients for AF recurrence.
  
  
  RESULTS
  AF recurrence was demonstrated in 45 patients (20%, age 68±13 years) after spontaneous sinus conversion. Patients with recurrence had larger left atrial volume index (32±12 vs 25±10 mL/m2, P<0.001), left ventricle mass index (107±34 vs 93±25 g/m2, P=0.012), and left ventricle filling pressure (E/e'') (14±7 vs 12±5, P=0.012), whereas early diastolic mitral annular velocity (e') (5±2 vs 6±3 cm/s, P=0.021), late diastolic mitral annular velocity (A') (7±3 vs 9±2 cm/s, P<0.001), and peak systolic mitral annular velocity (7±2 vs 8±2 cm/s, P=0.045) were significantly lower. In multivariate Cox regression analysis detecting independent predictors of PaAF recurrence, lower A' (hazard ratio: 0.623, 95% confidence interval: 0.476-0.815, P=0.001) was a significant predictor of AF recurrence.
  
  
  CONCLUSIONS
  A', which indicates left atrial (LA) contractile function after sinus conversion, was the independent predictor of PaAF recurrence, whereas LA volume was not. LA function may be more important than LA volume in predicting recurrence particularly in patients with PaAF.
authors.affiliation: Cardiology Division, Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Yoon
authors.forename: Jeonggeun
authors.initials: J
authors.lastname: Moon
authors.forename: Hye moon
authors.initials: Hm
authors.lastname: Chung
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Jong-Youn
authors.initials: JY
authors.lastname: Kim
authors.forename: Pil-ki
authors.initials: PK
authors.lastname: Min
authors.forename: Young-won
authors.initials: YW
authors.lastname: Yoon
authors.forename: Byoung-kwon
authors.initials: BK
authors.lastname: Lee
authors.forename: Bum-kee
authors.initials: BK
authors.lastname: Hong
authors.forename: Hyuck-moon
authors.initials: HM
authors.lastname: Kwon
authors.forename: Se-Joong
authors.initials: SJ
authors.lastname: Rim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology*; D016275:Atrial Function / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity