Improvement of atrial and ventricular strain after cardioversion of persistent atrial fibrillation

Introduction We aimed to detect early atrial morphologic and functional changes after successful electric cardioversion of atrial fibrillation (AF) and to correlate them to alterations of left and right ventricular strain Method All patients with successful electric cardioversion of persistent AF were included in a prospective monocentric study between August 2018 and August 2019. They had a transthoracic echocardiography before cardioversion (TTE 1) and 2 months later (TTE2). Left atrial (LA) and ventricular volumes, left ventricular ejection fraction (LVEF), left and right ventricular global longitudinal strain (GLS), LA strain and ejection fraction (LAEF) were measured. Recurrent AF was ruled out by a 24-hours ECG monitoring after 2 months Results We included 29 men and 7 women 66 +-9.7 yo, with CHA2DS2VASC Score 2.5 (0-8),AF lasting for 21.2 ± 27.7 months and LVEF 53.7 ± 14.7%. At 2 months follow-up, sinus rhythm was maintained in 28 patients (78%). Patients with recurrent AF had no modification of volumes and function when comparing TTE 1 and TTE2. Patients with sustained sinus rhythm improved their LA volume (TTE1: 43 ± 14.5 ml/m2; TTE2: 34.5 ± 13 ml/m2; P = 0.001), LAEF (TTE1: 38.4 ± 15.7%; TTE2: 61.4 ± 15.7%; P = 0.0001) and LA strain (TTE1: 13.8 ± 7.4%; TTE2: 30.7 ± 17.5%; P = 0.0001). The left ventricular GLS (TTE 1: -12 ± 5%; TTE 2: -19.1 ± 5.6%; P = 0.0001) and right ventricular GLS (TTE 1: -10 ± 4.5%; TTE2: -17.6± 4.5%; P = 0.0001) were also improved while there was no significant change in LVEF (TTE 1: 55.5 ± 15.8%; TTE2: 59.1 ± 10.8%; P = 0.128). There was a correlation between LA strain changes and left ventricular GLS improvement (r = 0.53; P = 0.001) and between left and right GLS improvements (r = 0.6; P = 0.0001) Conclusion Sinus rhythm maintenance after AF cardioversion is associated to early improvement of, not only LA volume and function, but also left and right ventricular strain