The mechanical fibrillation pattern of the atrial myocardium is associated with acute and long-term success of electrical cardioversion in patients with persistent atrial fibrillation.
BACKGROUND
Electrophysiological studies demonstrate that a short atrial fibrillation cycle length (AFCL) is related with poor outcome of electrical cardioversion (ECV) of atrial fibrillation (AF). We found previously that the mechanical AFCL (AFCL-tvi) and atrial fibrillatory velocity (AFV-tvi) may be determined noninvasively using color tissue velocity imaging (TVI) and closely relates to the electrophysiological AFCL.


OBJECTIVE
To evaluate the relation between AFCL-tvi, AFV-tvi, and success of ECV in patients with AF.


METHODS
We prospectively studied 133 patients with persistent AF by performing echocardiography before ECV and measured the AFCL-tvi and AFV-tvi in the right atrium and left atrium. Recurrent AF was monitored.


RESULTS
Nineteen (14%) patients had failure of ECV, 42 (32%) remained in sinus rhythm after 1-year follow-up, and 72 (54%) had a recurrence of persistent AF. Patients with immediate ECV failure had a lower median AFV-tvi measured in the right atrium than did patients with a successful ECV: 0.7 cm/s (0.2-1.0 cm/s) vs. 1.7 cm/s (0.9-2.8 cm/s) (P = .008). Patients with maintenance of sinus rhythm after 1 year had a longer AFCL-tvi measured in the left atrium than did patients with recurrence of AF (150 ms vs 137 ms; P = .017) and had a higher AFV-tvi in both atria (1.4 vs. 0.9 cm/s in the left atrium; P = .013 and 2.2 vs 1.4 cm/s in the right atrium; P = .011). Multivariate analyses showed that all atrial TVI parameters were independently associated with the maintenance of sinus rhythm after 1 year.


CONCLUSIONS
Higher atrial fibrillatory wall velocities and longer AFCLs determined by echocardiography are associated with acute and long-term success of ECV.
Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: cees.devos@yahoo.com.
Cees B
CB
De Vos
Maastricht University Medical Centre, Maastricht, The Netherlands.
Ione
I
Limantoro
Maastricht University Medical Centre, Maastricht, The Netherlands.
Ron
R
Pisters
Maastricht University Medical Centre, Maastricht, The Netherlands.
Tammo
T
Delhaas
Maastricht University Medical Centre, Maastricht, The Netherlands.
Ulrich
U
Schotten
Maastricht University Medical Centre, Maastricht, The Netherlands.
Emile C
EC
Cheriex
Maastricht University Medical Centre, Maastricht, The Netherlands.
Robert G
RG
Tieleman
Maastricht University Medical Centre, Maastricht, The Netherlands.
Harry J G M
HJ
Crijns
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
Atrial fibrillation; Cardioversion; Echocardiography; Electrophysiology; Prognosis