Early improvement of cardiac performance after atrial fibrillation direct current cardioversion

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is the most common arrhythmia and one of the most prevalent cardiac disease. Restoring sinus rhythm improves long-term systolic and diastolic function, quality of life and relieve symptoms in patients with symptomatic AF. Purpose The aim of the study was to evaluate the early effects of AF direct current cardioversion on myocardial deformation using speckle-tracking echocardiography. Methods 51 patients with persistent AF who underwent successful direct current cardioversion were enrolled (age: 70 ± 9 years; men: 72.5%). Patients with ischemic, dilatative, hypertrophic cardiomyopaties, valvular heart disease, previous cardiac interventions were excluded from the study. Left ventricular ejection fraction was 55.2 ± 7.0%. A transthoracic echocardiography was performed one day before the successful cardioversion and 6 hours after, employing 2d standard echocardiography and speckle-tracking technique to evaluate left atrial, left ventricular and free-wall right ventricular longitudinal strain. Results Restoration of sinus rhythm led to a reduction of the heart rate (83 ± 14 vs 70 ± 13 bpm, p < 0.001). After about six hours from successful AF direct current cardioversion, we highlighted an increase in left ventricular filling pressure estimated with the ratio E/E’ (8.19 ± 0.29 vs 9.34 ± 0.41, p = 0.0016). A significant increase in left atrial longitudinal strain (10.47 ± 0.64% vs 19.76 ± 1.01%, p < 0.001, Figure A) and in left ventricular longitudinal strain (-13.10 ± 0.60% vs -15.86 ± 0.51%, p < 0.001, Figure C) were noticed; also the free wall right ventricular longitudinal strain increased (-12.06 ± 1.16% vs -15.86 ± 1.29%, p = 0.047, Figure B). Conclusion Restoring sinus rhythm improves cardiac performance as evidenced by the increase in either left atrial and bi-ventricular longitudinal strain, suggesting an amelioration even if after early time. Abstract Figure