P259The atrial function after cardioversion for atrial fibrillation: one month of echocardiographic follow up


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Abstract

Background: Atrial fibrillation is the most common arrhythmia in clinical practice. Echocardiography is important for an initial evaluation and for the management in patient presenting AF. It is also useful to assess the left atrial (LA) function recovery after cardioversion(CV) to SR.The aim of the study was to assess the LA function recovery after CV for persistent AF to SR through a one month follow up.Population. We enrolled 34 pts (mean age 65 ±12,32 y.o.) who underwent successful CV from AF to SR. 17,7% had a recent onset of AF (less than 48 h), in the 41,1% AF lasts more than 7 days and less than 3 months and in the 42,4% AF lasts more than 3 months. We excluded patients with severe cardiovascular diseases (severe valvular disease, low EF) or previous transcatheter ablation.Methods: Each patient underwent an echo study before CV. After restoration of the SR echo was repeated at day 0, after 48 hours, 1 week, 2 weeks, 3 weeks and at one month from CV. Echo parameters evaluated were: LA size (linear measurements, areas, volumes), total emptying fraction[TEF], active emptying fraction [AEF],A wave by PW, Aa by PW TDI, speckle tracking LA. Statistical analysis was performed by repeated measures analysis of variance.Results: LA volumes were average enlarged (46.5±17.8 ml/m2). We had no reductions in volume (p=0.8) and diameter (p=0.9). Statistically significant differences were recorded analyzing the TEF (p<0.0001), with a significant increase from baseline in the first week, and of the AEF(p<0.001) with significant increase from baseline in the 3rd week. We had similar results analyzing the A wave by PW (p<0.005),the Aa wave by TDI (p<0.001) and velocity of the atrial basal segments studied by speckle tracking (p=0.03). Dividing the population by the onset of arrhythmia, patients with AF lasting <7 days had a prompt recovery either of the total emptying function (p = 0.03) either of the active emptying function (stable values from the first control in SR, no significant improvement during FU). In patients with AF lasting from 7-90 days and in those with AF duration > 90 days we had a significant recovery of TEF and AEF (7-90 days: TEF p=0.01 AEF p =0,01,> 90 days TEF p=0,01 AEF p=0.002) with a significant improvement at the fourth week of FU (p=0.003).Conclusion: Echocariography plays a key role in the evaluation of the LA. It is important to add to the traditional measurements (LA volume, A and wave Aa), functionality parameters such as the TEF, AEF. The offline analysis by speckle tracking can also be useful. Moreover the timing of CV is critical for the recovery of the LA function.

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