Reversible impairment of left and right ventricular systolic and diastolic function during short-lasting atrial fibrillation in patients with an implantable atrial defibrillator: A tissue doppler imaging study

Abstract

AF with a fast ventricular response may cause ventricular mechanical impairment, though whether short-lasting AF with satisfactory rate control may affect ventricular function is unknown. This study investigated if prompt cardioversion by an implantable atrial defibrillator (IAD) may prevent left (LV) and right ventricular (RV) systolic and diastolic dysfunction. Ten patients (mean age 61 ± 9 years, 8 men) with paroxysmal AF without structural heart disease who received an IAD were studied by echocardiography and tissue Doppler imaging (TDI) for both ventricles. Measurements were made during baseline sinus rhythm and at 1-minute, 20-minute, 4-hour, and 1-week postcardioversion of an episode of spontaneous AF. The occurrence AF and the ventricular rate were monitored at 2-hour intervals by the device. There were 50 episodes AF with a mean duration of 8.8 ± 8.9 days (2 hours to 37 days). There was no difference in M-mode measured L V fractional shortening and ejection fraction between baseline sinus rhythm and after cardioversion, However, the TDI derived myocardial systolic velocity (TDI-S) was significantly lower at 1-minute postcardioversion and was normalized at 1 week in both LVs (baseline: 5.7 ± 1.8, 1 minute: 4.2 ± 1.0, 20 minutes: 4.3 ± 0.9, 4 hours: 4.8 ± 1.0, 1 week: 5.5 ± 1.8 cm/s; P < 0.005 when comparing 1 minute and 20 minutes to baseline; P < 0.05 when comparing 4 hour to baseline) and RV (baseline: 10.4 ± 2.1, 1 minute: 7.8 ± 1.4, 20 minutes: 8.1 ± 1.2, 4 hours: 9.2 ± 1.5, 1 week: 10.0 ± 2.0 cm/s; P < 0.005 when comparing 1 minute, 20 minutes, and 4 hours to baseline). For diastolic function, transmittal Doppler study showed a decrease in early filling velocity at I minute (P < 0.05) and 20 minutes (P < 0.005), which was normalized at 4 hours. There was no change in transtricuspid Doppler flow. However, TDI derived myocardial early filling velocity was decreased in the LV (baseline: 6.0 ± 2.8, 1 minute: 5.4 ± 2.3, 20 minutes: 5.4 ± 2.1, 4 hours: 6.1 ± 2.2, 1 week: 5.8 ± 1.7 cm/s; P < 0.05 when comparing 1 minute and 20 minutes to baseline) and RV (baseline: 8.9 ± 3.5, 1 minute: 7.9 ± 3.3, 20 minutes: 8.1 ± 3.3, 4 hours: 8.5 ± 2.9, 1 week: 8.4 ± 3.5 cm/s; P < 0.05 when comparing 1 minute to baseline). AF of a longer duration (> 48 hours) resulted in a more depressed TDI-S in LV (> 48 hours: 4.2 ± 1.0, ≤ 48 hours: 5.3 ± 1.3 cm/s; P < 0.01). Shocks in sinus rhythm did not affect uny of the above echocardiographic parameters. Therefore, despite adequate rate control, short-lasting AF impairs systolic and diastolic function in both ventricles, which improves gradually after cardioversion. Early restoration of sinus rhythm by an IAD minimizes ventricular dysfunction. TDI is a sensitive tool to assess early systolic and diastolic dysfunction.