title: Left atrial and left atrial appendage functional recovery after cardioversion in patients with recent atrial fibrillation: Serial echocardiographic study.
abstract: BACKGROUND
  The aim of this study is to point out timing of left atrium and its appendage functional recovery after cardioversion (CV) in recent onset atrial fibrillation (AF).
  
  
  METHODS
  Fifty patients; 27 within 48-h (group I) and 23 after 48-h (group II), of AF onset, who had successful CV underwent transthoracic echocardiography (TTE), before and immediately after CV, then 15, 30 and 90 days later. Transesophageal echocardiography (TEE) was performed for group II before and for all patients immediately after CV and 1 month later. Mitral peak A velocity and left atrial (LA) reversal (Ar) velocity, tissue Doppler imaging (TDI) of septal mitral annular velocity (A1) and LA free wall velocity (A3) were recorded. Absence or peak A velocity < 50 cm/s was taken as a cut off value for atrial stunning. Intra-atrial conduction time (IACT) was measured. LA appendage late emptying (LAALE) velocity was measured by TEE-pulsed TDI of LA appendage.
  
  
  RESULTS
  Post CV, all group II and 34% of group I experienced stunning. In both groups, peak A, Ar, A1, A3 and LAALE velocities increased (p = 0.000), while IACT decreased (p = 0.000) progressively over time. Partial recovery occurred after 15 and 30 days, while full recovery occurred 30 and 90 days post CV in groups I and II, respectively. IACT1 and IACT2 correlated with LA diameter (r = 0.2778 and r = 0.227, respectively, p < 0.01).
  
  
  CONCLUSIONS
  Stunning and functional recovery of the LA and its appendage are strongly determined by the duration being in AF. Serial IACT by TDI was a good new parameter for detection of functional recovery of LA and LA appendage.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Ammar
authors.forename: Islam
authors.initials: I
authors.lastname: Elsherbiny
authors.affiliation: Cardiology Department, Faculty of Medicine, Zagazig University, Egypt. ibtesamaldosoky@yahoo.com.
authors.forename: Ibtesam I
authors.initials: II
authors.lastname: El-Dosouky
authors.forename: Khaled
authors.initials: K
authors.lastname: Abd El Salam
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abd El Hamid
authors.forename: Wael
authors.initials: W
authors.lastname: Khalil
authors.forename: Mas
authors.initials: M
authors.lastname: Ammar
mesh_terms: D000328:Adult; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016279:Atrial Function, Left; D001783:Blood Flow Velocity / Q000502:physiology; D004452:Echocardiography / Q000379:methods*; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: atrial fibrillation; atrial stunning; left atrial appendage function; left atrial function