Predicting maintenance of sinus rhythm after cardioversion - novel versus conventional left atrial parameters

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The successful electrical cardioversion (EC) in patients with atrial fibrillation (AF) improves cardiac mechanical function and enables early assessment of atrial activity by echocardiography. Purpose To analyze conventional and novel parameters characterizing left atrium (LA) within 24 hours after the restoration of sinus rhythm (SR) and their prognostic value during 2-years follow-up. Methods Prospective study involved 71 patients with nonvalvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echo 24 hours after conversion to SR. In addition, standard echocardiographic and Doppler parameters were assessed. Using speckle-tracking method we analysed LA longitudinal strain in reservoir and contractile phase. The clinical endpoint was predefined as AF recurrence. Results During a 24-months follow-up we noticed AF recurrence in 48 (68%) patients. The median time-to-event was 2.4 months (IQR 1 to 6.9). Standard echo measurements revealed a median of LV ejection fraction 55% (IQR 45-58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34-51). Median mitral A wave was 0.46 m/s (IQR 0.39-0.5) vs 0.35 m/s (IQR 0.28-0.5) in patients without and with AF recurrence, respectively (p = 0.04). Patients without AF recurrence had also higher mitral annular A’ velocity obtained by tissue Doppler imaging (7.4 ± 2.8 cm/s vs 3.5 cm/s, IQR 2.8-4.8; p < 0.0001), LA reservoir strain (19.4 ± 7.3% vs 11%, IQR 9.6-15.3; p = 0.0003) and LA contractile strain (9.4 ± 4.1% vs 2.8%, IQR 1.2-4.4; p < 0.0001). The table presents results derived from univariate Cox regression analysis. Conclusion LA activity assessed early after the restoration of sinus rhythm is the predictor of AF recurrence. The strongest association was proven for LA contractile strain. Abstract Figure. Univariate Cox regression analysis