Prospective analysis of echocardiographic predictors related with atrial fibrillation relapse in atrial fibrillation patients with sinus rhythm after cardioversion

Objective: Identifying echographic predictors of AF relapse during follow-up in patients undergone cardioversion (CV) due to atrial fibrillation (AF) was aimed. Method: A total of 100 patients who had undergone CV due to new or previous diagnosis of persistent or paroxysmal AF was enrolled in this study. Volume and diameter of left ventricle (LV) and left atrium (LA), left ventricular ejection fraction , volume indices, right atrium diameter and volume, right ventricle end-diastolic diameter (RVEDD) and systolic pulmonary arterial pressure (sPAB), tricuspid annular plain systolic excursion (TAPSE) and mitral annular plain systolic excursion (MAPSE), mitral E/A wave velocities and deceleration time (DT), mitral e',a' and s' velocities, atrial conduction times were measured by transthoracic echocardiography (TEE) after cardioversion; then interatrial and intraatrial electromechanic conduction delays were calculated. Patients were evaluated with clinical routine examination, ECG and 24-hour Holter monitoring at 1st, 3rd, 6th and 12th months. Results: Relapse was observed in %34 (n=34) of patients. Patients with newly diagnosed AF and patients with AF lasting <1 week had lower rate of relapse whereas patients with AF lasting more than 1 year had higher of relapse. Relapse group had significantly higher CHA2DS2VASc score, chronic obstructive pulmonary disease (COPD), serum CRP levels and LA diameter, LA volume (LAHvp) and minimum LA volume (LAHmin) at start of atrial systole and their indices according to the body surface area (LAHIvp and LAHImin; respectively), LV mass (LVM), LV mass index (LVMI), sPAB, RVEDD. Also, mitral A, a', s' velocities were significantly lower whereas left atrium conduction time (p-LA) and total conduction time (TCT), right intraatrial electromechanic conduction delay (RIECD) were significantly longer. In logistic regression analysis, it was found that relapse risk decreases with newly diagnosed AF (p=0.0001) and increased with presence of COPD (p=0.011), high CHA2DS2VASc score (p=0.002) and low A wave velocity (p=0.015). Conclusion: Newly diagnosed AF is an independent predictor of relapse decrease whereas presence of COPD, high CHA2DS2-VASc score and low A wave velocity are independent predictors of relaps increase. Early diagnosis and treatment of concomittant diseases are important factors for preserving sinus rhythm. Key words: Atrial fibrillation, cardioversion, relapse, echocardiography, atrial electromechanic delay