The role of atrial myocardial deformation parameters in prediction of cardioversion success in atrial fibrillation patients

aim of the study was to determine the role of atrial deformation parameters in prediction of conversion to sinus rythm in persistant atrial fibrillation patients. Between March 2012 and January 2013, 60 patients with persistant atrial fibrillation were evaluated before cardioversion in Akdeniz University Cardiology outpatient clinic. And 40 patients (23 male, 17 female) who met the inclusion criteria were evaluated in the study. After echocardiographic evaluation suitable patients were hospitalized. After sedation with IV midazolam, as designated by the ACC/AHA/ESC guidelines, DCCV was performed with Philiphs Heartstart XL biphasic defibrillator device with anterolateral approach. The DCCV was performed for each patient starting with 150J and in case of unsuccess the CV was performed with increasing the energy to 200J and 200J respectively. And in case of unsuccess the CV was again performed with 200 J with anteroposterior approach. The cardioversion procedure was accepted as unsuccesfull if sinus rythm could not be achieved despite all attempts. Patients were monitorized after procedure for 24 hours. At the end of 24 hours, if sinus rythm were maintained patients were accepted in group 1 (successful cardioversion), if not accepted in group 2 (unsuccessful cardioversion). Patients in group 1 were accepted in group 1A (not recurrent) if the sinus rythm was maintained at the end of 1 month, if not accepted in group 1B (recurrent). In the cardioversion unsuccessful patients (group 2), global left atrial strain (LA strain S) and global left atrial strain rate S (LA strain rate S) parameters were lower than the patients with successful cardioversion (group 1), and the difference was statistically significant. However global left atrial strain rate E (LA strain rate E) parameters were not differrent among groups. To predict the success of cardioversion, LA strain, strain rate and LAVI parameters were compared with ROC analysis. The area under curve for LAVI was 0,851±0,065, for global LA strain S it was 0,712±0,058 and for global LA strain rate S it was 0,889±0,053. The area under curve for both of the parameters were statistically significant (LAVI, global LA strain S and LA strain rate S; p:<0,001, p:0,0032, p:<0,001 respectively). The most distinctive LAVI value to estimate the success of cardioversion was found as 39 ml/m² (sensitivity: 80%, specifity: 100%). The most distinctive global LA strain S value to estimate the cardioversion succes was found as 7,465% (sensistivity: 92%, specifity: 60%) and global LA strain rate S value was found as 0,7 (sensivity: 72%, specifity: 93%). Patients with successful cardioversion were grouped according to electrocardiography recorded one month after cardioversion; sinus rythm (group 1A) and reccurrent atrial fibrillation (group 1B). In group 1A global left atrial strain rate S parameters recorded before and after cardioversion were found to be higher than group 1B patients and the difference was statistically significant. Global left atrial strain S parameter recorded before cardioversion was not different among group 1A and group 1B patients. Group 1A patients have higher global left atrial strain S values than group 1B which were recorded after cardioversion, and the difference was statistically significant. The global left atrial strain rate E parameter was not different among group 1A and group 1B. In our study, we showed that left atrial myocardial deformation parameters can also be used to estimate cardioversion success in persistant atrial fibrillation, likewise conventional echocardiographic parameters. Besides, we showed similiar sensitivity and specifity of left atrial strain rate S parameter and left atrial volume index in estimating the cardioversion success. Left atrial miyocardial deformation parameters determined by 2D speckle tracking is a useful, sensitive and specific noninvasive method to evaluate left atrial functions and to estimate cardioversion success in persistant atrial fibrillation patients