Segmental atrial contraction in patients restored to sinus rhythm after cardioversion for chronic atrial fibrillation: a colour Doppler tissue imaging study.

Aims: There is little known about segmental atrial function in patients with atrial arrhythmias. We evaluated segmental atrial contractility using colour Doppler tissue imaging (CDTI) in patients with chronic atrial fibrillation (CAF) who were successfully restored and maintained in sinus rhythm (SR).

Methods And Results: We compared the segmental atrial contractility in 39 CAF patients who were successfully cardioverted and maintained in SR for 6 months. Follow up echocardiograms were performed at baseline, 1 week, 1 month and 6 months and compared to a normal age matched cohort (n = 34). Using CDTI, mean peak velocities of atrial contraction were measured from annular, mid and superior segments of lateral and septal walls of the left atrium and right atrium in the apical four-chamber view. Segmental velocities from the posterior and anterior walls of the left atrium were measured from the apical two-chamber view. Segmental left atrial velocities improved over time in the CAF group, with the majority of the recovery occurring in the first month, but failed to normalise even at 6 months. In comparison, the right atrial velocities in the AF group had normalised at 1 month.

Conclusion: Patients with CAF have persistent segmental left atrial dysfunction even 6 months after restoration and maintenance of SR, though right atrial velocities appear to normalise. This differential recovery indicates that left atrial function remains subnormal in patients with CAF despite maintenance of SR, suggesting underlying atrial myopathy or fibrosis as a consequence of CAF.