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.

Abstract

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±10.6years; 35% women) with persistent AF and successful eCV were prospectively enrolled. The PA-TDI interval was measured 6h and 90days post-cardioversion. AF relapse was determined via 7-day Holter-ECG immediately after eCV and repeated after 90days. Early recurrent AF (within 7days) 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 90days compared to patients who remained in sinus rhythm (SR) (149.1±8.3 vs. 129.8±10.9ms, p<0.0001). Optimal cut-off values for recurrent AF after 7 or 90days from ROC analysis were 142 and 143ms, respectively. Furthermore, the PA-TDI interval decreased significantly from baseline in those who remained in SR (129.8±10.9 vs. 125.8±10ms, p<0.0001), whereas the PA-TDI interval increased in patients who developed AF after 90days (149.1±8.3 vs. 152±9ms, 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.