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Effects of Sinus Rhythm Maintenance on Left Heart Function After Electrical Cardioversion of Atrial Fibrillation: Implications for Tachycardia-Induced Cardiomyopathy

Zimmermann, A. J. and Bossard, M. and Aeschbacher, S. and Schoen, T. and Voellmin, G. and Suter, Y. and Lehmann, A. and Hochgruber, T. and Pumpol, K. and Sticherling, C. and Kuhne, M. and Conen, D. and Kaufmann, B. A.. (2015) Effects of Sinus Rhythm Maintenance on Left Heart Function After Electrical Cardioversion of Atrial Fibrillation: Implications for Tachycardia-Induced Cardiomyopathy. Canadian Journal of Cardiology, 31 (1). pp. 36-43.

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Official URL: https://edoc.unibas.ch/62155/

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Abstract

BACKGROUND: The role of tachycardia-induced cardiomyopathy vs tachycardia-related short diastolic filling period and reduced atrial contraction in decline of left ventricular ejection fraction (LVEF) in atrial fibrillation (AF) is uncertain. We aimed to characterize left heart changes over time in patients with AF who undergo electrical cardioversion (ECV). METHODS: Consecutive AF patients who were to undergo ECV were enrolled. Patients with unstable or acute heart failure, severe valvular diseases, recent open-heart surgery, major disorders, or an unsuccessful ECV were excluded. Transthoracic echocardiography, including 3-dimensional left atrial and ventricular volume acquisitions, was performed 1-2 hours before and after ECV, and 4-6 weeks later. RESULTS: In 73 patients (77% male, 66 +/- 11 years), ECV resulted in an immediate increase in LVEF (from 43 [interquartile range (IQR), 33-50%] to 48 [IQR, 40-53%]; P > 0.0001). Four to 6 weeks after ECV, ejection fraction increased further in patients who remained in sinus rhythm (SR) (n = 55) to 55 (IQR, 44-62)%; P > 0.001. In patients with AF relapse, LVEF returned to values comparable to pre-ECV (n = 18) (44 [IQR, 32-51]%; P = 0.03). The atrial emptying fraction did not significantly change immediately after ECV (n = 69; from 20 [IQR, 13-25]% to 20 [IQR, 15-28]%; P = 0.14). Only patients who remained in SR showed an increase in atrial emptying fraction after 4-6 weeks (n = 51; to 37 [IQR, 26-48]%; P > 0.0001 vs post-ECV). CONCLUSIONS: Immediate improvement in LVEF after ECV explains approximately 50% of total LVEF increase over time. However, in SR, LVEF, and atrial function continuously increase over 4-6 weeks after ECV. This might be attributable to recovery of tachycardia-induced cardiomyopathy.
Faculties and Departments:03 Faculty of Medicine > Departement Biomedizin > Department of Biomedicine, University Hospital Basel > Cardiovascular Molecular Imaging (Kaufmann)
UniBasel Contributors:Kaufmann, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Elsevier
ISSN:0828-282X
e-ISSN:1916-7075
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:13 Nov 2018 19:21
Deposited On:13 Nov 2018 19:21

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