title: Absence of left atrial stunning after cardioversion of recent-onset atrial fibrillation in patients at low-stroke risk.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the presence and degree of spontaneous echo contrast (SEC) in the left atrium and of left atrial appendage (LAA) contractility before and after cardioversion (CV) in patients with recent-onset atrial fibrillation (AF).
  
  
  METHODS
  Our study included 56 patients divided into two groups: group 1, comprising 32 clinically stable patients who were admitted to the Emergency Department with less than or equal to 48 h duration AF, and who underwent transoesophageal echocardiography (TEE)-guided CV; and the control group (group 2), comprising 24 patients admitted to the Cardiological Department for elective TEE-guided CV of greater than 48 h AF. All patients underwent repeat TEE within 1 h after successful CV.
  
  
  RESULTS
  Patients with recent-onset AF (group 1) showed no thrombogenic milieu at baseline without any evidence of atrial stunning after successful CV. SEC mean grade (0-3 grading) was 0.09±0.3 versus 0.12±0.4 after CV (P=0.98), and LAA flow velocity was 60.7±19.4 versus 56.7±20.5 cm/s after CV (P=0.07). Group 2 patients showed a significantly higher degree of SEC compared with those in group 1 (0.09±0.3 vs. 0.66±0.7, P=0.0093) and significantly lower LAA flow velocities (60.7±19.4 vs. 32.5±12.4, P<0.0001), with significant worsening after successful CV (SEC degree: 0.66±0.9 vs. 1.37±0.9, P=0.0093; LAA flow velocity: 32.5±12.4 vs. 20.4±12.7 cm/s, P<0.0001).
  
  
  CONCLUSIONS
  The absence of thrombogenic milieu and of left atrial stunning after CV in patients with recent-onset AF favours early CV without anticoagulation, at least in patients with a low thromboembolic risk profile. These patients could be discharged earlier from urgent care.
authors.affiliation: aDepartment of Cardiology, S.S. Annunziata Hospital, Savigliano Department of bCardiology cDepartment of Medical Physics, Ordine Mauriziano Hospital, Torino dDepartment of Medicine, Casa di Cura Città di Bra, Bra, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Antonielli
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pizzuti
authors.forename: Sarah
authors.initials: S
authors.lastname: Dogliani
authors.forename: Michele
authors.initials: M
authors.lastname: Stasi
authors.forename: Antonia
authors.initials: A
authors.lastname: Bassignana
authors.forename: Baldassarre
authors.initials: B
authors.lastname: Doronzo
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy*; D004452:Echocardiography; D004554:Electric Countershock / Q000009:adverse effects; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000209:etiology*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*