External cardioversion of persistent atrial fibrillation significantly improved left ventricular peak longitudinal strain from -12.9% to -18.0% at 6 hours post-procedure.
Cohort (n=48)
No
Does successful external cardioversion improve acute left ventricular performance measured by longitudinal strain in patients with persistent atrial fibrillation?
Successful external cardioversion of persistent atrial fibrillation results in a rapid and significant improvement in left ventricular performance, as measured by longitudinal strain, though this benefit may be attenuated by baseline inflammation.
Absolute Event Rate: -18% vs -12.9%
p-value: p=<0.001
Introduction: Atrial fibrillation (AF) is often associated with heart failure. Several studies have demonstrated that resumption of sinus rhythm (SR) improves cardiac output in the long-term. Aims of this study were to evaluate the acute variations of left ventricular (LV) performance, following successful external cardioversion (ECV) of persistent AF using longitudinal strain (LSt) analysis, and the influence of inflammation. Materials and Methods: We enrolled 48 patients with AF (age: 73 ± 12 years, men: 83.3%). A standard transthoracic echocardiographic evaluation was performed before the procedure and 6 h later; this included the analysis of LV endocardial peak LSt, a measure of myocardial deformation. In the last 32 patients, plasma concentration of interleukin-6 (IL-6) was also determined. Results: Restoration of SR led to the decrease of heart rate (HR) (74 ± 21 vs 64 ± 10 bpm, P < 0.001) and LV end-systolic volume (30 ± 16 vs 27 ± 17 mL/m 2 , P = 0.001), and to the increase of LV end-diastolic volume (LVEDV) (56 ± 20 vs 60 ± 21 mL/m 2 , P = 0.036) and ejection fraction (EF) (48 ± 10 vs 57 ± 11%, P < 0.001). Peak LSt improved in 43 (89.6%) patients (-12.9 ± 3.3 vs -18.0 ± 4.7%, P < 0.001). Multivariate analysis (R = 0.729, P < 0.001) showed that strain changes were directly correlated with basal HR and the appearance of atrial mechanical activity and inversely correlated with corrected thyroid dysfunction, LVEDV and the presence of a permanent pacemaker. Higher levels of IL-6 negatively affected LV performance improvement. Conclusions: Effective ECV of AF determines a significant and fast improvement of LV performance, which is readily captured by LSt analysis. Inflammatory status may impact the response to SR restoration.
Fumagalli et al. (Wed,) conducted a cohort in Persistent atrial fibrillation (n=48). External cardioversion (ECV) vs. Baseline (pre-cardioversion) was evaluated on Peak longitudinal strain (LSt) (p=<0.001). External cardioversion of persistent atrial fibrillation significantly improved left ventricular peak longitudinal strain from -12.9% to -18.0% at 6 hours post-procedure.