title: Usefulness of the Atrial Emptying Fraction to Predict Maintenance of Sinus Rhythm After Direct Current Cardioversion for Atrial Fibrillation.
abstract: Atrial volumes indexed to body surface area (AVI) are robust predictors of nonvalvular atrial fibrillation (AF) recurrence after direct current cardioversion (DCCV). The incremental value of atrial emptying fraction (EmF) compared with atrial volumes as a predictor for recurrent AF after DCCV has not been evaluated. We sought to compare the predictive ability of baseline left atrial (LA) EmF, right atrial (RA) EmF, LAVI, and RAVI for post-DCCV AF recurrence at 6 months. The first 95 patients enrolled in the AF Clinic Registry with adequate echocardiogram imaging constituted the study cohort. Each patient underwent echocardiogram within 6 months before cardioversion. Maximal LAVI and RAVI, LA EmF, and RA EmF were performed offline using 4-chamber single-plane Simpson's method, averaged over 5 cycles. The mean age of the study cohort was 64 ± 12 years, and 67% were men. Only 28 patients (29%) who underwent DCCV remained in sinus rhythm at 6 months of follow-up. The remaining, 67 (71%) had reverted to AF or underwent ablation during the 6 months of follow-up. The overall performance for prediction of AF recurrence was greatest for RA EmF, area under the receiver operator characteristic curve (AUC): RA EmF 0.92, LA EmF 0.89, RAVI 0.76, and LAVI 0.63. RA and LA EmF AUCs were significantly higher than for LAVI or RAVI (max p = 0.02). In conclusion, although RAVI and LAVI are strong predictors of AF recurrence after DCCV, RA and LA EmF outperformed in this cohort.
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Luong
authors.affiliation: Department of Clinical Research Services, EMMES Canada, Burnaby, British Columbia, Canada; Department of Statistics, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Darby J S
authors.initials: DJ
authors.lastname: Thompson
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Gin
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Jue
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Parvathy
authors.initials: P
authors.lastname: Nair
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Pui-Kee
authors.initials: PK
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Tsang
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marion E
authors.initials: ME
authors.lastname: Barnes
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Colley
authors.affiliation: Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: t.tsang@ubc.ca.
authors.forename: Teresa S M
authors.initials: TS
authors.lastname: Tsang
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D004452:Echocardiography; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D000889:Anti-Arrhythmia Agents