title: Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation.
abstract: OBJECTIVE
  Little is known about the impact of left-ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) recurrence in patients with left-atrial (LA) dilation. To evaluate, in patients with symptomatic persistent AF and LA dilation, the incremental role of LV diastolic dysfunction in predicting early AF recurrence after cardioversion (CV).
  
  
  RESULTS
  From July 2011 to July 2013, 175 patients with persistent AF referred to our centre for CV were screened. Inclusion criteria were: European Heart Rhythm Association (EHRA) class ≥2 despite optimal medical treatment and heart rate at rest ≤80 bpm, LA volume ≥34 mL/m(2), EF > 35%, absence of untreated ischaemic disease and significant valvular disease, successful CV. Finally, 127 patients (age 64 ± 10 years, 60% EHRA ≥3, LA volume 42 ± 15 mL/m(2)) were enrolled. At 3 months, 37 (29%) patients presented AF recurrence. At univariate analysis, AF duration >90 days before CV (P < 0.01), septal e' <8 cm/s (P 0.03), and septal E/e' ratio ≥11 (P < 0.001) but no LA dimensions significantly correlated with AF recurrence. Logistic regression analysis confirmed septal E/e' ratio ≥11 as the best predictor of recurrence (OR 3.25 95% CI 1.19-8.86 P 0.001) together with an AF duration >90 days before the CV (OR 2.69 95% CI 1.01-7.53 P 0.04). At ROC curve analysis, the septal E/e' ratio ≥11 showed the best diagnostic accuracy (AUC 0.66, 95% CI 0.55-0.76, P 0.007).
  
  
  CONCLUSIONS
  In this population with symptomatic persistent AF and LA enlargement, septal E/e' ratio ≥11 and AF duration >90 days predicted AF recurrence at 3 months.
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy cristina.fornengo@alice.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fornengo
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Antolini
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Frea
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gallo
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Grosso Marra
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Morello
authors.affiliation: Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D015331:Cohort Studies; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D007090:Image Interpretation, Computer-Assisted; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Atrial fibrillation; Cardioversion; Diastolic function; Left atrial volume