Control Subjects In Sinus Rhythm Research Articles

Lone Atrial Fibrillation Is Associated With Impaired Left Ventricular Energetics That Persists Despite Successful Catheter Ablation.

Lone atrial fibrillation (AF) may reflect a subclinical cardiomyopathy that persists after sinus rhythm (SR) restoration, providing a substrate for AF recurrence. To test this hypothesis, we investigated the effect of restoring SR by catheter ablation on left ventricular (LV) function and energetics in patients with AF but no significant comorbidities. Fifty-three patients with symptomatic paroxysmal or persistent AF and without significant valvular disease, uncontrolled hypertension, coronary artery disease, uncontrolled thyroid disease, systemic inflammatory disease, diabetes mellitus, or obstructive sleep apnea (ie, lone AF) undergoing ablation and 25 matched control subjects in SR were investigated. Magnetic resonance imaging quantified LV ejection fraction (LVEF), peak systolic circumferential strain (PSCS), and left atrial volumes and function, whereas phosphorus-31 magnetic resonance spectroscopy evaluated ventricular energetics (ratio of phosphocreatine to ATP). AF burden was determined before and after ablation by 7-day Holter monitoring; intermittent ECG event monitoring was also undertaken after ablation to investigate for asymptomatic AF recurrence. Before ablation, both LV function and energetics were significantly impaired in patients compared with control subjects (LVEF, 61% [interquartile range (IQR), 52%-65%] versus 71% [IQR, 69%-73%], P<0.001; PSCS, -15% [IQR, -11 to -18%] versus -18% [IQR, -17% to -19%], P=0.002; ratio of phosphocreatine to ATP, 1.81±0.35 versus 2.05±0.29, P=0.004). As expected, patients also had dilated and impaired left atria compared with control subjects (all P<0.001). Early after ablation (1-4 days), LVEF and PSCS improved in patients recovering SR from AF (LVEF, 7.0±10%, P=0.005; PSCS, -3.5±4.3%, P=0.001) but were unchanged in those in SR during both assessments (both P=NS). At 6 to 9 months after ablation, AF burden reduced significantly (from 54% [IQR, 1.5%-100%] to 0% [IQR 0%-0.1%]; P<0.001). However, LVEF and PSCS did not improve further (both P=NS) and remained impaired compared with control subjects (P<0.001 and P=0.003, respectively). Similarly, there was no significant improvement in atrial function from before ablation (P=NS), and this remained lower than in control subjects (P<0.001). The ratio of phosphocreatine to ATP was unaffected by heart rhythm during assessment and AF burden before ablation (both P=NS). It was unchanged after ablation (P=0.57), remaining lower than in control subjects regardless of both recovery of SR and freedom from recurrent AF (P=0.006 and P=0.002, respectively). Patients with lone AF have impaired myocardial energetics and subtle LV dysfunction, which do not normalize after ablation. These findings suggest that AF may be the consequence (rather than the cause) of an occult cardiomyopathy, which persists despite a significant reduction in AF burden after ablation.

PP.14.03] PLASMA MARKERS OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH HYPERTENSION AND ATRIAL FIBRILLATION

Objective: To evaluate plasma markers of endothelial dysfunction in patients with hypertension and different categories of atrial fibrillation (AF). Design and method: The study included 113 hypertensive patients aged 34 to 72 years (mean age 60.2 ± 5.7 years). Based on AF category, patients were divided into 3 groups: the first group consisted of 50 patients with paroxysmal AF; 33 patients with permanent AF were included into the second group, and 30 patients in sinus rhythm were designated as the control group. The plasma collagen-binding activity of von Willebrand factor (vWf) and endothelin-1 (ET-1) level were measured in all the patients. Results: Collagen–binding activity vWf was significantly higher in patients with hypertension and permanent AF (150 IU/dl, p < 0.05) in comparison with the patients with paroxysmal AF (106 ± 12 IU/dl, p = 0.04) and the controls (84 ± 11 IU/dl, p = 0.001). There was a significant direct correlation between AF paroxysm frequency per year and collagen-binding activity of vWf in hypertensive patients with paroxysmal AF (r = 0.59041). No significant differences in the average ET-1 levels were observed between the patients with AF and hypertensives in sinus rhythm. The plasma ET-1 level was directly associated with the grade of hypertension in all the groups. Conclusions: Collagen–binding activity of vWf did not correlate with the grade of hypertension and was significantly higher in patients with permanent AF when compared with the control group subjects. There was a significant direct correlation between AF paroxysm frequency and collagen-binding activity of vWf in patients with paroxysmal AF. Plasma endothelin-1 level was directly associated with the grade of hypertension in both AF patients and the control subjects in sinus rhythm. No correlation between ET-1 level and AF category was found.

Upregulation of K(2P)3.1 K+ Current Causes Action Potential Shortening in Patients With Chronic Atrial Fibrillation.

Antiarrhythmic management of atrial fibrillation (AF) remains a major clinical challenge. Mechanism-based approaches to AF therapy are sought to increase effectiveness and to provide individualized patient care. K(2P)3.1 (TASK-1 [tandem of P domains in a weak inward-rectifying K+ channel-related acid-sensitive K+ channel-1]) 2-pore-domain K+ (K(2P)) channels have been implicated in action potential regulation in animal models. However, their role in the pathophysiology and treatment of paroxysmal and chronic patients with AF is unknown. Right and left atrial tissue was obtained from patients with paroxysmal or chronic AF and from control subjects in sinus rhythm. Ion channel expression was analyzed by quantitative real-time polymerase chain reaction and Western blot. Membrane currents and action potentials were recorded using voltage- and current-clamp techniques. K(2P)3.1 subunits exhibited predominantly atrial expression, and atrial K(2P)3.1 transcript levels were highest among functional K(2P) channels. K(2P)3.1 mRNA and protein levels were increased in chronic AF. Enhancement of corresponding currents in the right atrium resulted in shortened action potential duration at 90% of repolarization (APD90) compared with patients in sinus rhythm. In contrast, K(2P)3.1 expression was not significantly affected in subjects with paroxysmal AF. Pharmacological K(2P)3.1 inhibition prolonged APD90 in atrial myocytes from patients with chronic AF to values observed among control subjects in sinus rhythm. Enhancement of atrium-selective K(2P)3.1 currents contributes to APD shortening in patients with chronic AF, and K(2P)3.1 channel inhibition reverses AF-related APD shortening. These results highlight the potential of K(2P)3.1 as a novel drug target for mechanism-based AF therapy.

Asymmetric Dimethylarginine Levels are Highly Associated With Atrial Fibrillation in an Elderly Population.

BackgroundThe importance of endothelial dysfunction in atrial fibrillation (AF) is not clarified. The aim of this study was to evaluate endothelial dysfunction assessed by selected inflammatory and haemostatic endothelial markers and nitric oxide (NO) associated variables as related to the presence of AF in an elderly population. NO is known to express anti-thrombotic as well as vasoactive properties.MethodsThis is a cross sectional study of 75-year old subjects with AF (n = 62) and control subjects in sinus rhythm (n = 124), matched for gender. Fasting blood samples were collected for analyses of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO-synthase, L-arginine, E-selectin, vascular cell adhesion molecule-1 (VCAM-1) and von Willebrand factor (vWF).ResultsLevels of vWF and ADMA were significantly higher in AF patients vs controls (P = 0.023 and P < 0.001, respectively) and the L-arginine/ADMA ratios were lower (P = 0.015), the latters still significant after adjustment for relevant covariates (P = 0.007 and P = 0.037, respectively). No significant differences in the levels of VCAM-1 and E-selectin were observed between the groups. When dividing the ADMA levels into quartiles there was a significant trend for having AF with increasing levels of ADMA (P < 0.001) with a cut-off at the 25th percentile (< 0.54 µmol/L), giving an adjusted OR for having AF of 12.46 (95% CI 3.11 - 49.86) (P < 0.001) with higher levels. A similar inverse trend was seen for the L-arginine/ADMA ratio.ConclusionOur population of 75-year-old AF patients had significantly impaired endothelial function assessed by increased levels of vWF, and more pronounced by high levels of ADMA. The results indicate AF in the elderly to be closely associated with the regulatory pathway of NO.

Lung function and dyspnea in patients with permanent atrial fibrillation

Background Reduced forced expiratory volume in one second (FEV 1) has been associated with new-onset atrial fibrillation (AF), and AF patients often complain of dyspnea. We hypothesized that patients with permanent AF had reduced lung function compared to subjects in sinus rhythm. Methods The participants were 75 year-olds from the general population. FEV 1, forced vital capacity (FVC), maximal voluntary ventilation (MVV), total lung capacity by single breath (TLC SB), single-breath diffusing capacity of the lung for carbon monoxide (DLCO SB) and exercise testing with peak oxygen uptake (VO 2 peak) were assessed. The slope of minute ventilation over carbon dioxide output defined ventilatory efficiency. The Symptom Checklist-frequency and severity questionnaire assessed dyspnea. Results AF patients had significantly higher number (%) of subjects below the 5th percentile of predicted FEV 1 (7 (27) versus 3 (4), p = 0.005), FVC (6 (23) versus 2 (3), p = 0.006) and TLC SB (11 (42) versus 12 (18), p = 0.014) compared to control subjects, also after adjustment for smoking and obesity, or if disregarding subjects with chronic heart failure. The dyspnea frequency and severity scores correlated with VO 2 peak (r = − 0.6, p < 0.01) in AF patients, and in control subjects with % predicted FEV 1, MVV and TLC SB (r = − 0.3, p < 0.05). Conclusion More patients with permanent AF had lung function below normal range than control subjects in sinus rhythm, irrespective of smoking, obesity or chronic heart failure. Dyspnea, however, was related to exercise capacity rather than to lung function in AF patients.

E0547 Left atrium function in patients with paroxysmal atrial fibrillation: analysis from two-dimensional speckle tracking echocardiography

IntroductionTo observe the changes of left atrium function in patients with paroxysmal atrial fibrillation (AF) using two-dimensional (2D) speckle tracking echocardiography (STE).MethodsThe study population consisted of 33 patients with paroxysmal...

Neuropsychological deficits in asymptomatic atrial fibrillation.

To assess the preclinical effects on cognitive functions of nonrheumatic atrial fibrillation (NRAF) in patients with negative history for cerebrovascular disease. The study included 37 consecutive patients with chronic (n=16, mean age 65.3+/-6.6 years) or paroxysmal (n=21, mean age 58.3+/-9.5 years) NRAF and an equal number of control subjects in sinus rhythm, who were matched for age, education and presence of hypertension. A comprehensive neuropsychological battery including tests of attention, memory, language and visuospatial skills was administered. Patients with chronic NRAF showed significantly poorer performances in tasks exploring attention and verbal memory functions, while the paroxysmal group was significantly impaired in a long-term memory task. The neuropsychological findings were confirmed excluding from both groups patients with CT evidence of cerebrovascular damage. A small subgroup of patients was also submitted to cerebral MRI. Neurologically asymptomatic NRAF is related to a subclinical but significant impairment in attention and memory. These deficits could be produced by minor ischemic lesions due to microembolization, or by diffuse hypoxic damage due to hypoperfusion.

Extracellular Matrix Alterations in Patients With Paroxysmal and Persistent Atrial Fibrillation: Biochemical Assessment of Collagen Type-I Turnover

We investigated whether the serum markers of collagen turnover differed in various forms of atrial fibrillation (AF) and in sinus rhythm (SR) in humans. Structural alterations and fibrosis have been implicated in the generation and perpetuation of AF. Serum C-terminal propeptide of collagen type-I (CICP), C-terminal telopeptide of collagen type-I (CITP), matrix metalloproteinase-1, and tissue inhibitor of matrix metalloproteinases-1 were measured as markers of collagen synthesis and degradation in 70 patients with AF and 20 healthy control subjects in SR. C-terminal propeptide of collagen type-I and CITP were significantly higher in AF patients than in control subjects (91 +/- 27 ng/ml vs. 67 +/- 11 ng/ml, p < 0.001 and 0.38 +/- 0.20 ng/ml vs. 0.25 +/- 0.08 ng/ml, p < 0.001, respectively). Persistent AF patients had higher levels of CICP (105 +/- 28 ng/ml vs. 80 +/- 21 ng/ml, p < 0.001), but not CITP, compared with those with paroxysmal AF. Patients with persistent AF had lower levels of matrix metalloproteinase-1 but increased levels of tissue inhibitor of matrix metalloproteinases-1 compared with patients with paroxysmal AF (11.90 +/- 4.79 ng/ml vs. 14.98 +/- 6.28 ng/ml, p = 0.03 and 155 +/- 45 ng/ml vs. 130 +/- 38 ng/ml, p < 0.001, respectively). Tissue inhibitor of matrix metalloproteinases-1 levels were significantly lower in control subjects compared with those in both paroxysmal and persistent AF patients (102 +/- 15 ng/ml vs. 130 +/- 38 ng/ml vs. 155 +/- 45 ng/ml, respectively, p < 0.001). Serum markers of collagen type-I turnover differed significantly between patients with AF and SR. Furthermore, these markers also differed significantly between paroxysmal and persistent AF patients, suggesting that the intensity of the extracellular synthesis and degradation of collagen type-I may be related to the burden or type of AF.

Soluble E-selectin, von Willebrand Factor, Soluble Thrombomodulin, and Total Body Nitrate/Nitrite Product as Indices of Endothelial Damage/Dysfunction in Paroxysmal, Persistent, and Permanent Atrial Fibrillation

Atrial fibrillation (AF) is associated with a prothrombotic state, which is related to endothelial damage/dysfunction. Plasma levels of soluble E-selectin (sE-sel), von Willebrand factor (vWf), and soluble thrombomodulin (sTM) have been used as indexes of endothelial activation, damage/dysfunction, and endothelial damage, respectively. Nitric oxide is also made by a healthy endothelium, and a total body nitrate/nitrite product (NOx) is used as a measure of endothelial nitric oxide production. We hypothesized that the levels of these markers of endothelial function would be abnormal in patients with paroxysmal, persistent, and permanent AF. We studied 145 AF patients (paroxysmal AF, 35 patients; permanent AF, 50 patients; persistent AF, 60 patients) and 35 patients with "lone" AF. Plasma levels of sE-sel, vWf, and sTM (measured by enzyme-linked immunosorbent assay) and NOx (measured by a colorimetric assay based on the Griess reaction) were compared to 40 age-matched healthy control subjects in sinus rhythm. Patients with AF had significantly higher plasma levels of vWf (p < 0.001) and sE-sel (p = 0.005) compared with control subjects, but sTM and NOx levels were not significantly different. Levels did not differ significantly among the clinical subgroups of patients with paroxysmal, persistent, and permanent AF. Patients with lone AF had significantly higher vWF levels (p = 0.003) and significantly lower sTM levels (p = 0.0361) compared to control subjects, but sE-sel and NOx levels were not significantly different. There were no significant differences in the AF study population in vWF, sE-sel or sTM levels after 4 weeks of warfarin treatment. Endothelial perturbation exists in all clinical subgroups of patients with AF, including those with lone AF, which may contribute to the prothrombotic state seen in these patients.

Is thrombogenesis in atrial fibrillation related to matrix metalloproteinase-1 and its inhibitor, TIMP-1?

Decreased matrix metalloproteinase-1 (MMP-1) and increased levels of its inhibitor, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), reflect impaired matrix degradation with an increase in fibrosis. A prothrombotic state has been described in atrial fibrillation (AF), increasing the risk of stroke and thromboembolism. Because structural abnormalities and remodeling of atria have been observed in AF, we hypothesized that the prothrombotic state in AF may be related to abnormal indexes of matrix degradation. We studied 48 consecutive patients (30 men; age, 70.5+/-9.0 years) with chronic nonrheumatic AF who were not on anticoagulation. Plasma levels of MMP-1, TIMP-1, and prothrombin fragment 1+2 (F1+2, an index of thrombogenesis) were measured by enzyme-linked immunosorbent assay. M-mode, 2-dimensional, and Doppler echocardiographic studies were performed in all patients. Research indexes were compared with data from 32 control subjects in sinus rhythm who were of similar age and sex. Patients with AF had lower levels of MMP-1 (P=0.011) but increased levels of TIMP-1 (P=0.033) and F1+2 (P<0.001) and a higher ratio of TIMP-1 to MMP-1 (P=0.009) compared with control subjects. After adjustment for sex, age, hypertension, and diabetes, TIMP-1 levels and the ratio of TIMP-1 to MMP-1 correlated with F1+2 levels (r=0.24, P=0.038; and r=0.26, P=0.023, respectively). In multivariate analysis, there was no independent relationship between MMP-1, TIMP-1, or ratio of TIMP-1 to MMP-1 and the presence of AF. Patients with AF have evidence of impaired matrix degradation, but this was not independently associated with the presence of AF on multivariate analysis. However, an independent relationship was found between the MMP/TIMP system and prothrombotic state (assessed by F1+2 levels).

Electrophysiologic actions of dl-sotalolin patients with persistent atrial fibrillation

ObjectivesWe sought to determine the electrophysiologic actions of sotalol in the remodeled atrium of humans. BackgroundIn experimental studies, sotalol has limited class III action in the electrically remodeled atrium and did not prevent atrial fibrillation (AF) induction. MethodsWe determined the effective refractory periods (ERPs) at three pacing cycle lengths (400, 500, and 600 ms) in the high right atrium (HRA) and distal coronary sinus (DCS) before and after intravenous infusion of dl-sotalol in 10 patients with persistent AF who underwent internal cardioversion. The same protocols were performed in 10 control subjects in sinus rhythm. ResultsIn the HRA and DCS, the atrial ERPs at different drive cycle lengths were significantly shorter in patients with AF than in control subjects (p < 0.05). In patients with AF, the atrial ERP’s adaptation to rate was nearly normal in the HRA, but was poor in the DCS. In both groups, dl-sotalol significantly increased the atrial ERPs at both the HRA and DCS, as compared with baseline (p < 0.05). However, the prolongation of atrial ERPs was significantly less at a drive cycle length of 600 ms in patients with AF versus control subjects (p < 0.05). After infusion of dl-sotalol, the atrial ERP’s adaptation to rate at both the HRA and DCS was poor in patients with AF, and AF was still easily inducible in the majority of them, but not in control subjects. ConclusionsThe results of the present study demonstrate that the electrophysiologic actions of dl-sotalol are significantly attenuated in the chronically remodeled human atrium, and these changes might represent a probable explanation for the low efficacy of dl-sotalol to prevent early AF recurrence after electrical cardioversion.

A cross-sectional and diurnal study of thrombogenesis among patients with chronic atrial fibrillation

OBJECTIVESFirst, we sought to determine whether there is diurnal variation in hemostatic factors related to thrombogenesis and hypercoagulability among patients with chronic atrial fibrillation (AF). Second, we sought to determine whether levels of soluble thrombomodulin (sTM), a marker of endothelial function, or soluble P-selectin (sP-sel), an index of platelet activation, are altered in patients with AF as compared with subjects in sinus rhythm.BACKGROUNDAtrial fibrillation is associated with an increased risk of stroke and thromboembolism and is known to confer a hypercoagulable state, with abnormalities of thrombosis, platelet activation and endothelial cell function. Many cardiovascular events, such as acute myocardial infarction, have thrombosis as an underlying process, and they undergo diurnal variation.METHODSFifty-two patients (45 men, mean [±SD] age 66 ± 6 years) with chronic AF, none of whom received antithrombotic therapy, were studied. Baseline levels of fibrinogen, sP-sel, sTM and von Willebrand factor (vWF) were compared to those levels in matched healthy control subjects in sinus rhythm. In a subgroup of 20 patients, five venous blood samples were collected through an indwelling cannula at 6-h intervals from 12 pm to 12 pm the following day and were analyzed for the same markers.RESULTSPatients with chronic AF had higher plasma sP-sel, sTM, vWF and fibrinogen levels as compared with control subjects in sinus rhythm. Significant correlations were found between fibrinogen and sP-sel in patients with AF (r = 0.567 [Spearman], p < 0.001) and in control subjects (r = 0.334, p = 0.016). There was no significant diurnal variation in plasma levels of sP-sel, sTM, vWF or fibrinogen over the 24-h study period (repeated measures analysis of variance, p = NS).CONCLUSIONSThere is no circadian or diurnal variation in the hypercoagulable state seen in AF, as assessed by plasma fibrinogen and markers of platelet (sP-sel) and endothelial function (vWF and sTM). The persistent hypercoagulable state, together with the loss of diurnal variation in various hemostatic markers, in chronic AF may contribute to the high risk of stroke and thromboembolic complications in these patients.

Left Ventricular Systolic Wall Motion Velocities Along the Long and Short Axes Measured by Pulsed Tissue Doppler Imaging in Patients with Atrial Fibrillation

Pulsed tissue Doppler imaging was performed to measure systolic left ventricular (LV) posterior wall motion velocity along the long and short axes and to evaluate the relationships between the systolic variables and the maximum first derivative (peak dP/dt) of the LV pressure curve and the 2 preceding R-R intervals in 39 patients with atrial fibrillation (AF). The study group consisted of 22 patients with AF only, 17 patients with dilated or ischemic cardiomyopathy and AF, and 25 healthy control subjects in sinus rhythm. The systolic component of the LV posterior wall motion velocity was divided into the first (Sw 1 ) and second (Sw 2 ) systolic waves. The peak Sw 1 along the long axis was greater than either that along the short axis or the peak Sw 2 s along the long and short axes in the control and AF-only groups. The peak Sw 1 along the long axis was lower in the AF-only group than in the control group, and those along the short and long axes were lower in the dilated AF group than in the other groups. The peak Sw 1 almost coincided with the peak dP/dt. The peak Sw 1 along the long axis correlated closely with the peak dP/dt, and the ratio of the preceding R-R interval to the interval before the preceding (“prepreceding”) R-R interval in both AF groups, particularly in the dilated AF group, and the slopes of their relationships were steeper in the dilated AF group than in the AF-only group. The peak Sw 2 along the short axis was greater than that along the long axis in the control and AF-only groups. The peak Sw 2 along the long axis was lower in the AF-only group than in the control group, and those along the short and long axes were lower in the dilated AF group than in the other groups. The peak dP/dt was lower and the LV end-diastolic pressure was higher in the dilated AF group than in the other groups. In conclusion, peak Sw 1 along the long axis is useful for the evaluation of isovolumic myocardial LV contractility, and the interval-force relation and the Frank-Starling mechanism are important factors of beat-to-beat variability in systolic LV function in patients with AF. (J Am Soc Echocardiogr 1999;12:121-8.)

Relation between QT and RR intervals during exercise testing in atrial fibrillation

The ability to predict the RR-QT relation over a range of heart rates was evaluated in 10 patients with atrial fibrillation (AF) and in 10 control subjects in sinus rhythm. The data from each subject were fitted by regression into 3 QT prediction formulas (the square root formula of Bazett, the cube root formula of Fridericia and the exponential formula of Sarma) applied in standard form and modified with a weighted average of the preceding 5 RR intervals. The goodness-of-fit of each formula was evaluated using mean square residual and Akaike information criterion. For AF, the mean square residuals did not differ among the 3 standard QT prediction formulas (Bazett 624 ± 274, Fridericia 625 ± 274 and Sarma 611 ± 267) and among the 3 modified QT prediction formulas (Bazett 507 ± 325, Fridericia 496 ± 255 and Sarma 495 ± 328). The weighted average modification produced a significant decrease in mean square residuals for all 3 equations (p < 0.05) in all patients. These findings were confirmed by Akaike information criterion. Goodness-of-fit in sinus rhythm was similar to previously published reports, and significantly better than the fit for AF (p < 0.0001). For 9 of the 10 patients with AF, sinus rhythm electrocardiograms were obtained and the above regression equations were used to predict QT intervals. Comparing the measured and predicted QT intervals, the best correlation was produced by the modified form of the Fridericia equation (r 2 = 0.93); the mean r 2 value was 0.86 ± 0.07. The proposed modification of previously described QT prediction formulas takes into account the gradual nature of the influences of the preceding RR intervals and may be clinically useful in correcting the QT interval in AF.

Suspected thyrotoxicosis.

<h3>Introduction</h3> To observe the changes of left atrium function in patients with paroxysmal atrial fibrillation (AF) using two-dimensional (2D) speckle tracking echocardiography (STE). <h3>Methods</h3> The study population consisted of 33 patients with paroxysmal atrial fibrillation and 30 age, sex-matched control subjects in sinus rhythm (SR) who were referred to our echocardiography laboratory. All of the patients were in sinus rhythm when they were checked. Left atrial diameter (LAD), left atrial area (LAA), interventricular septum thickness (IVST); Left ventricular end-diastolic diameter (LVEDD) were measured in 2-dimensional echocardiography imaging. LV ejection fraction was determined. Measured mitral valve A wave velocity time integral (VTI-A) and maximum velocity (VA). LA wall strain in the longitudinal direction obtained using 2DSTE. Measured peak atrial longitudinal strain (PALS) and atrial contraction longitudinal strain (ACLS) in apical 4-chamber view and apical 2- chamber view. Measured time to peak longitudinal strain (TPLS). ∆\TPLS was defined as the difference between the TPLS in apical 4-chamber view and apical 2- chamber view. <h3>Results</h3> There were no significant differences between the 2 groups regarding age (63±12 vs 60±9 years), sex (males 48% vs 60%) and history of hypertension and diabetes mellitus. Compared with control group, ∆-TPLS were significantly increased in AF group (52.83±32.2 vs 31.33±20.2, p&lt;0.05). In Patients with AF, ACLS were significantly decreased than in control group (10.09±3.3 vs 13.74±3.1 p&lt;0.05). The PALS; LAD; LVEDD; IVS; EF; VA; VTI-A and LAA between paroxysmal AF and control group did not show statisticant difference (p&gt;0.05). <h3>Conclusions</h3> 2DSTE can effectively and easily measure LA ∆-TPLS and ACLS, speckle tracking echocardiography could be a method to non-invasively assess LA function in paroxysmal atrial fibrillation patients.