Volume : 1, Issue : 1, OCT 2017


Mehrnoush Toufana, BabakKazemib, NeginMolazadehc


Aim: The purpose of this study is to evaluate of the significance of the left atrial volume index (LAVI) measurement performed before ECV in predicting the recurrence of the AF. Methods and materials: Fifty-one patients with AF, selected for ECV were studied in the cardiology department of Tabriz University of medical sciences. The clinical and demographic data of all the patients were recorded. Echocardiography was performed before and also three months after ECV. Patients were divided into two groups: those who maintained SR and those with recurrent AF based on their clinical manifestations and ECG taken after three months. Results: SR was maintained in 76.5 percent of the patients following the three months after ECV. The age, sex and the BMI were not significantly different between SR and AF groups. Two groups showed no significant differences considering pre-ECV medical history including medications and systemic diseases. The initial LAVI was significantly different between two groups. The cut-off point of LAVI value in predicting the maintenance of SR was 55 ml/m2. The LAVI of SR group decreased significantly after three months. Conclusion: The present study demonstrates that LAVI is a powerful predictor of the recurrence of AF after ECV. The LAVI measurement could be a useful method in the selection of the patients with AF for ECV.


Atrial fibrillation, cardioversion, left atrial volume.

Article : Download PDF

Cite This Article

Article No : 2

Number of Downloads : 79


Akdemir, B., Altekin, R. E., Kucuk, M., Yanikoglu, A., Karakas, M. S., Aktas, A., Demir, I. &Ermis, C. (2013). The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy. AnadoluKardiyolDerg, 13, p. 18-25. Aribas, A., Akilli, H., Gul, E. E., Kayrak, M., Demir, K., Duman, C., Alibasic, H., Yazici, M., Ozdemir, K. &Gok, H. (2013). Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion? AnadoluKardiyolDerg, 13, p. 123-130. Blich, M. &Edoute, Y. (2006). Electrical cardioversion for persistent or chronic atrial fibrillation: outcome and clinical factors predicting short and long term success rate. Int J Cardiol, 107, p. 389-394. Brodsky, M. A., Allen, B. J., Capparelli, E. V., Luckett, C. R., Morton, R. & Henry, W. L. (1989). Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation. Am J Cardiol, 63, p. 1065-1068.
Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G., Kirchhof, P., Guidelines-CPG, E. S. C. C. f. P. & Document, R. (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace, 14, p. 1385-1413. Carlsson, J., Tebbe, U., Rox, J., Harmjanz, D., Haerten, K., Neuhaus, K. L., Seidel, F., Niederer, W. &Miketic, S. (1996). Cardioversion of atrial fibrillation in the elderly. ALKK-Study Group. ArbeitsgemeinschaftLeitenderKardiologischerKrankenhausaerzte. Am J Cardiol, 78, p. 1380-1384. Casaclang-Verzosa, G., Gersh, B. J. & Tsang, T. S. (2008). Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am CollCardiol, 51, p. 1-11. European Heart Rhythm, A., European Association for Cardio-Thoracic, S., Camm, A. J., Kirchhof, P., Lip, G. Y., Schotten, U., Savelieva, I., Ernst, S., Van Gelder, I. C., Al-Attar, N., Hindricks, G., Prendergast, B., Heidbuchel, H., Alfieri, O., Angelini, A., Atar, D., Colonna, P., De Caterina, R., De Sutter, J., Goette, A., Gorenek, B., Heldal, M., Hohloser, S. H., Kolh, P., Le Heuzey, J. Y., Ponikowski, P., Rutten, F. H. & Guidelines, E. S. C. C. f. P. (2010). Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace, 12, p. 1360-1420. Frick, M., Frykman, V., Jensen-Urstad, M., Ostergren, J. &Rosenqvist, M. (2001). Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation. ClinCardiol, 24, p. 238-244. Kataoka, T., Hamasaki, S., Inoue, K., Yuasa, T., Tomita, K., Ishida, S., Ogawa, M., Saihara, K., Koriyama, C., Nobuyoshi, M., Sakata, R. &Tei, C. (2010). Left atrium volume index and pathological features of left atrial appendage as a predictor of failure in postoperative sinus conversion. J Cardiol, 55, p. 274-282. Kim, Y. H., Lee, S. C., Her, A. Y., Kim, H. J., Choi, J. O., Shin, D. H., Cho, S. W., Lee, W. S., Park, S. W. & Park, P. W. (2007). Preoperative left atrial volume index is a predictor of successful sinus rhythm restoration and maintenance after the maze operation. J ThoracCardiovascSurg, 134, p. 448-453.
Kosior, D. A., Szulc, M., Torbicki, A., Opolski, G. &Rabczenko, D. (2005). A decrease of enlarged left atrium following cardioversion of atrial fibrillation predicts the long-term maintenance of sinus rhythm. Kardiol Pol, 62, p. 428-437; discussion 438-429. Kuppahally, S. S., Foster, E., Shoor, S. &Steimle, A. E. (2009). Short-term and long-term success of electrical cardioversion in atrial fibrillation in managed care system. Int Arch Med, 2, p. 39. Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W. & Voigt, J. U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am SocEchocardiogr, 28, p. 1-39 e14. Lee, Y. S., Hyun, D. W., Jung, B. C., Cho, Y. K., Lee, S. H., Shin, D. G., Park, H. S., Han, S. W., Kim, Y. N. & Group, K. T. K. C. E. W. (2010). Left atrial volume index as a predictor for occurrence of atrial fibrillation after ablation of typical atrial flutter. J Cardiol, 56, p. 348-353. Lester, S. J., Ryan, E. W., Schiller, N. B. & Foster, E. (1999). Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol, 84, p. 829-832. Lim, T. K., Ashrafian, H., Dwivedi, G., Collinson, P. O. & Senior, R. (2006). Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: Implication for diagnosis of diastolic heart failure. Eur J Heart Fail, 8, p. 38-45. Lip, G. Y., Tse, H. F. & Lane, D. A. (2012). Atrial fibrillation. Lancet, 379, p. 648-661. Maddukuri, P. V., Vieira, M. L., DeCastro, S., Maron, M. S., Kuvin, J. T., Patel, A. R. & Pandian, N. G. (2006). What is the best approach for the assessment of left atrial size? Comparison of various unidimensional and two-dimensional parameters with three-dimensional echocardiographically determined left atrial volume. J Am SocEchocardiogr, 19, p. 1026-1032. Marchese, P., Bursi, F., Delle Donne, G., Malavasi, V., Casali, E., Barbieri, A., Melandri, F. & Modena, M. G. (2011). Indexed left atrial volume predicts the recurrence of non-valvular atrial fibrillation after successful cardioversion. Eur J Echocardiogr, 12, p. 214-221.
Masson, S., Aleksova, A., Favero, C., Staszewsky, L., Bernardinangeli, M., Belvito, C., Cioffi, G., Sinagra, G., Mazzone, C., Bertocchi, F., Vago, T., Peri, G., Cuccovillo, I., Masuda, N., Barlera, S., Mantovani, A., Maggioni, A. P., Franzosi, M. G., Disertori, M., Latini, R. & investigators, G.-A. (2010). Predicting atrial fibrillation recurrence with circulating inflammatory markers in patients in sinus rhythm at high risk for atrial fibrillation: data from the GISSI atrial fibrillation trial. Heart, 96, p. 1909-1914.
Mitchell, A. R., Spurrell, P. A., Ahmet, H., Kempson, S., Higson, M. &Sulke, N. (2003). Echocardiographic changes and predictors of arrhythmia recurrence after long-term use of the atrial defibrillator. Int J Cardiol, 89, p. 25-31. Miyasaka, Y., Barnes, M. E., Gersh, B. J., Cha, S. S., Bailey, K. R., Abhayaratna, W. P., Seward, J. B. & Tsang, T. S. (2006). Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 114, p. 119-125. Osmanagic, A., Moller, S., Osmanagic, A., Sheta, H. M., Vinther, K. H. &Egstrup, K. (2016). Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion: An Echocardiographic Study. ClinCardiol, p. Pritchett, A. M., Jacobsen, S. J., Mahoney, D. W., Rodeheffer, R. J., Bailey, K. R. & Redfield, M. M. (2003). Left atrial volume as an index of left atrial size: a population-based study. J Am CollCardiol, 41, p. 1036-1043. Ristow, B., Ali, S., Whooley, M. A. & Schiller, N. B. (2008). Usefulness of left atrial volume index to predict heart failure hospitalization and mortality in ambulatory patients with coronary heart disease and comparison to left ventricular ejection fraction (from the Heart and Soul Study). Am J Cardiol, 102, p. 70-76. Rodevan, O., Bjornerheim, R., Ljosland, M., Maehle, J., Smith, H. J. &Ihlen, H. (1999). Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging, 15, p. 397-410. Schabelman, S., Schiller, N. B., Silverman, N. H. & Ports, T. A. (1981). Left atrial volume estimation by two-dimensional echocardiography. CathetCardiovascDiagn, 7, p. 165-178. Shin, S. H., Park, M. Y., Oh, W. J., Hong, S. J., Pak, H. N., Song, W. H., Lim, D. S., Kim, Y. H. & Shim, W. J. (2008). Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation. J Am SocEchocardiogr, 21, p. 697-702.
Sievers, B., Kirchberg, S., Addo, M., Bakan, A., Brandts, B. & Trappe, H. J. (2004). Assessment of left atrial volumes in sinus rhythm and atrial fibrillation using the biplane area-length method and cardiovascular magnetic resonance imaging with TrueFISP. J CardiovascMagnReson, 6, p. 855-863. Sousa, A. C. (2006). Left atrial volume as an index of diastolic function. Arq Bras Cardiol, 87, p. e27-33.
Toufan, M., Pourafkari, L., Nader N. (2015). 'Teapot' in the heart. Indian Heart Journal, http://dx.doi.org/10.1016/j.ihj.2015.11.005. Van Gelder, I. C., Crijns, H. J., Van Gilst, W. H., Verwer, R. & Lie, K. I. (1991). Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol, 68, p. 41-46. Wang, Y., Gutman, J. M., Heilbron, D., Wahr, D. & Schiller, N. B. (1984). Atrial volume in a normal adult population by two-dimensional echocardiography. Chest, 86, p. 595-601. Wang, Y. C., Lin, L. C., Lin, M. S., Lai, L. P., Hwang, J. J., Tseng, Y. Z., Tseng, C. D. & Lin, J. L. (2005). Identification of good responders to rhythm control of paroxysmal and persistent atrial fibrillation by transthoracic and transesophageal echocardiography. Cardiology, 104, p. 202-209.