What does this research mean for the field?

Recovery of left and right ventricular strain after cardioversion is inversely associated with long-term AF burden. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to determine the relationship between myocardial strain recovery after cardioversion and atrial fibrillation recurrence and burden.

February 2, 2026

Atrial fibrillation burden after cardioversion is associated with functional ventricular recovery: insights from strain imaging in a prospective cohort

Key Result

Recovery of left and right ventricular strain after cardioversion is inversely associated with long-term AF burden (p = 0.004 for LV-GLS; p = 0.028 for RV-FWS).

Key Points

This study aims to determine the relationship between myocardial strain recovery after cardioversion and atrial fibrillation recurrence and burden.
Conducted a prospective cohort study with 46 patients
Performed echocardiographic assessments of ventricular strain before and after elective cardioversion
Utilized continuous rhythm monitoring via implantable loop recorders for 12 months
Categorized AF burden based on percentage of time spent in AF
Analyzed data using one-way ANOVA for group comparisons.
Post-cardioversion, significant improvements in strain measurements were observed for all cardiac chambers
Increased LV-GLS and RV-FWS correlated inversely with long-term AF burden
Patients with >50% AF burden showed little to no improvement in strain
Early AF recurrence was associated with smaller improvements in all strain parameters

Structured PICO

Does recovery of myocardial strain following elective cardioversion predict early AF recurrence and long-term AF burden in patients with atrial fibrillation?

Population

n=46 patients with atrial fibrillation undergoing elective cardioversion

Intervention

Elective cardioversion followed by echocardiographic assessment of myocardial strain (LA reservoir strain, LV-GLS, RV-FWS) within 3 weeks, and continuous rhythm monitoring via implantable loop recorders

Outcome

Long-term atrial fibrillation burden (percentage of time spent in AF over 12 months) and early AF recurrence (AF reappearance within 30 days post-ECV)

Functional recovery of ventricular strain following elective cardioversion is strongly associated with long-term rhythm stability and lower AF burden.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Elective cardioversion (ECV) frequently restores sinus rhythm in patients with atrial fibrillation (AF); however, recurrence rates remain high, and reliable predictors of sustained rhythm control are limited. This study evaluated whether recovery of myocardial strain following ECV correlates with early AF recurrence and long-term AF burden, using continuous rhythm monitoring. Methods In this prospective cohort study, echocardiographic assessment—including left atrial reservoir strain (LA reservoir strain), left ventricular global longitudinal strain (LV-GLS), and right ventricular free wall strain (RV-FWS)—was performed prior to and within 3 weeks after ECV. Continuous rhythm data were collected over 12 months using implantable loop recorders. AF burden, defined as the percentage of time spent in AF, was categorized into five groups: 0%, 0–1%, 1.1–10%, 10–50%, and 50%. Early recurrence was defined as AF reappearance within 30 days post-ECV. Group comparisons were conducted using one-way ANOVA. Results A total of 46 patients were included. Significant post-ECV improvements in strain were observed in all chambers (mean ΔLA reservoir strain: +6.68 ± 7.71%, p0.001; ΔLV-GLS: –3.98 ± 3.26%, p0.001; ΔRV-FWS: –5.14 ± 5.22%, p0.001). Improvements in LV-GLS and RV-FWS were significantly associated inversely with long-term AF burden (ΔLV-GLS: p = 0.004; ΔRV-FWS: p = 0.028). LA reservoir strain changes did not differ significantly across burden categories (p = 0.147). Patients with 50% AF burden exhibited minimal or no improvement in ventricular strain (ΔLV-GLS: –0.4%; ΔRV-FWS: +1.14%). Additionally, early AF recurrence (30 days) was significantly associated with smaller improvements in all three strain parameters (ΔLV-GLS: p 0.001; ΔRV-FWS: p 0.001; ΔLA reservoir strain: p = 0.011). Conclusion Functional recovery of both the left and right ventricles following cardioversion was strongly associated with long-term rhythm stability. Although LA reservoir strain improved across all groups, it did not distinguish between AF burden outcomes. These findings suggest that ventricular strain recovery may serve as a marker of myocardial resilience and a predictor of cardioversion success.

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