Reverse atrial remodeling in patients who maintain sinus rhythm after electrical cardioversion: evidence derived from the measurement of total atrial conduction time assessed by PA-TDI interval.
A key mechanism of atrial fibrillation (AF) is atrial remodeling. Total atrial conduction time non-invasively assessed via tissue Doppler imaging (PA-TDI interval) may reflect the degree of electrical and structural atrial remodeling. The purpose of this study was to determine whether the PA-TDI interval is an independent predictor of recurrent AF after successful electrical cardioversion (eCV) and if it suggests reverse atrial remodeling.



Fifty-one patients (mean ± SD 66 ± 10.6 years; 35 % women) with persistent AF and successful eCV were prospectively enrolled. The PA-TDI interval was measured 6 h and 90 days post-cardioversion. AF relapse was determined via 7-day Holter-ECG immediately after eCV and repeated after 90 days.



Early recurrent AF (within 7 days) occurred in 21 patients (41.2 %), whereas after 90-day follow-up 26 patients (51 %) had AF recurrence. PA-TDI interval was longer in patients with AF recurrence within 90 days compared to patients who remained in sinus rhythm (SR) (149.1 ± 8.3 vs. 129.8 ± 10.9 ms, p < 0.0001). Optimal cut-off values for recurrent AF after 7 or 90 days from ROC analysis were 142 and 143 ms, respectively. Furthermore, the PA-TDI interval decreased significantly from baseline in those who remained in SR (129.8 ± 10.9 vs. 125.8 ± 10 ms, p < 0.0001), whereas the PA-TDI interval increased in patients who developed AF after 90 days (149.1 ± 8.3 vs. 152 ± 9 ms, p < 0.0001).



The PA-TDI interval is an independent predictor of early and mid-term AF recurrence after eCV. Moreover, our data suggests reverse atrial remodeling in those patients who remained in stable SR.
Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany. mueller.patr@googlemail.com.|Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany. mueller.patr@googlemail.com.
Patrick
P
Müller
Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany.
Fabian
F
Schiedat
Divisions of Endocrinology and Diabetes, Ruhr-University Bochum, Bochum, Germany.
Johannes-Wolfgang
JW
Dietrich
Division of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany.
Dong-In
DI
Shin
Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany.
Kaffer
K
Kara
Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany.
Andreas
A
Mügge
Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany.|Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
Thomas
T
Deneke
D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D064752:Atrial Remodeling; D004554:Electric Countershock; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
Atrial fibrillation; Electrical cardioversion; PA-TDI interval; Reverse atrial remodeling