Patrick Müller1,2, Fabian Schiedat3, Johannes-Wolfgang Dietrich4, Dong-In Shin5, Kaffer Kara3, Andreas Mügge3, Thomas Deneke3,6. 1. Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany. mueller.patr@googlemail.com. 2. Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany. mueller.patr@googlemail.com. 3. Divisions of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany. 4. Divisions of Endocrinology and Diabetes, Ruhr-University Bochum, Bochum, Germany. 5. Division of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany. 6. Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
Abstract
BACKGROUND: A key mechanism of atrial fibrillation (AF) is atrial remodeling. Total atrial conduction time non-invasively assessed via tissue Doppler imaging (PA-TDI interval) may reflect the degree of electrical and structural atrial remodeling. The purpose of this study was to determine whether the PA-TDI interval is an independent predictor of recurrent AF after successful electrical cardioversion (eCV) and if it suggests reverse atrial remodeling. METHODS: Fifty-one patients (mean ± SD 66 ± 10.6 years; 35 % women) with persistent AF and successful eCV were prospectively enrolled. The PA-TDI interval was measured 6 h and 90 days post-cardioversion. AF relapse was determined via 7-day Holter-ECG immediately after eCV and repeated after 90 days. RESULTS: Early recurrent AF (within 7 days) occurred in 21 patients (41.2 %), whereas after 90-day follow-up 26 patients (51 %) had AF recurrence. PA-TDI interval was longer in patients with AF recurrence within 90 days compared to patients who remained in sinus rhythm (SR) (149.1 ± 8.3 vs. 129.8 ± 10.9 ms, p < 0.0001). Optimal cut-off values for recurrent AF after 7 or 90 days from ROC analysis were 142 and 143 ms, respectively. Furthermore, the PA-TDI interval decreased significantly from baseline in those who remained in SR (129.8 ± 10.9 vs. 125.8 ± 10 ms, p < 0.0001), whereas the PA-TDI interval increased in patients who developed AF after 90 days (149.1 ± 8.3 vs. 152 ± 9 ms, p < 0.0001). CONCLUSIONS: The PA-TDI interval is an independent predictor of early and mid-term AF recurrence after eCV. Moreover, our data suggests reverse atrial remodeling in those patients who remained in stable SR.
BACKGROUND: A key mechanism of atrial fibrillation (AF) is atrial remodeling. Total atrial conduction time non-invasively assessed via tissue Doppler imaging (PA-TDI interval) may reflect the degree of electrical and structural atrial remodeling. The purpose of this study was to determine whether the PA-TDI interval is an independent predictor of recurrent AF after successful electrical cardioversion (eCV) and if it suggests reverse atrial remodeling. METHODS: Fifty-one patients (mean ± SD 66 ± 10.6 years; 35 % women) with persistent AF and successful eCV were prospectively enrolled. The PA-TDI interval was measured 6 h and 90 days post-cardioversion. AF relapse was determined via 7-day Holter-ECG immediately after eCV and repeated after 90 days. RESULTS: Early recurrent AF (within 7 days) occurred in 21 patients (41.2 %), whereas after 90-day follow-up 26 patients (51 %) had AF recurrence. PA-TDI interval was longer in patients with AF recurrence within 90 days compared to patients who remained in sinus rhythm (SR) (149.1 ± 8.3 vs. 129.8 ± 10.9 ms, p < 0.0001). Optimal cut-off values for recurrent AF after 7 or 90 days from ROC analysis were 142 and 143 ms, respectively. Furthermore, the PA-TDI interval decreased significantly from baseline in those who remained in SR (129.8 ± 10.9 vs. 125.8 ± 10 ms, p < 0.0001), whereas the PA-TDI interval increased in patients who developed AF after 90 days (149.1 ± 8.3 vs. 152 ± 9 ms, p < 0.0001). CONCLUSIONS: The PA-TDI interval is an independent predictor of early and mid-term AF recurrence after eCV. Moreover, our data suggests reverse atrial remodeling in those patients who remained in stable SR.
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