Bi-atrial and atrial appendages remodeling in patients with atrial fibrillation and spontaneous cardioversion

In atrial fibrillation (AF), few studies have focused on the influence of the mode of cardioversion, spontaneous (SpCV) versus non spontaneous (noSpCV) on bi-atrial cavities and appendages (right, RAA; left, LAA) remodeling.

We hypothesized that patients with SpCV might have a distinct morphological pattern in AF according to the mode of sinus rhythm conversion.

We prospectively studied 202 patients hospitalized for AF using two-dimensional (2D) transthoracic (TTE) and three-dimensional (3D) transoesophageal echocardiography (TEE) and evaluated RAA and LAA geometries (Figure 1). 3D parameters were off-line analysed using Ultrasound Workspace software (4D Cardio-View, Philips). Patients were divided into two groups according to cardiac rhythm within 24 hours after admission: SpCV group, 40 patients and noSpCV group, 162 patients.

Mean age was 66±11 years and 126 (62%) patients were male. SpCV group had in comparison with noSpCV group lower BNP levels (153 (66-233) versus 273.5(139.25-412.5) pg/mL, p<0.001) and lower HBA1c levels 5.5(5.3-5.7) versus 5.8 (5.6-6.2), p<0.001). Using 2D TTE, SpCV group had lower indexed left and right atrial end-systolic (ES) volume, lower E velocity (p<0.001), and higher left ventricle ejection fraction, LVEF (Table 1), as compared with with noSpCV group. Based on 2D and 3D TEE, SpCv group had in comparison with noSpCV group higher LAA emptying flow velocity and higher LAA filling flow velocity, lower 2D ES and end-diastolic (ED) LAA area, lower 3D ES and ED LAA volumes, lower 2D ES and ED RAA area, lower 3D ED RAA volumes (Table 1).

Bi-atrial and atrial appendages remodeling appear to be less important in SpCV group. Further investigations are warranted to determine the impact of such abnormalities on the risk of cardiovascular events in AF patients.