Background
Cardiac chamber remodeling in atrial fibrillation (AF) reflects heart rhythm progression and may affect functional regurgitation.
Goals
The purpose of this study was to explore three-dimensional echocardiographic variables of cardiac chamber remodeling and the impact on functional regurgitation in patients with AF with or without restoration of sinus rhythm at 12 months.
Methods
A total of 117 consecutive patients hospitalized for AF were examined by serial three-dimensional transthoracic echocardiography at admission, 6 months, and 12 months (337 examinations).
Results
During follow-up, 47 patients with active restoration of sinus rhythm (SR) (via cardioversion and/or ablation) had a decrease in all indexed atrial (Vi), end-systolic (ES), right ventricular (RV) volumes Vi, an increase in left ventricular LV at end diastole (ED) and an improvement in 4-chamber function (P < 0.05).
Patients with absence/failure of RS restoration (n = 39) had an increase in left atrial ED VI and ED/ES RV Vi without modification of 4-chamber function, except for a decrease in left atrial emptying fraction (P < 0.05).
Patients with spontaneous restoration of SR (n = 31) had no changes in LV or function.
The authors found an improvement from baseline in the severity of functional failure in patients with active restoration of SR (tricuspid and mitral regurgitation) and with spontaneous restoration of SR (tricuspid regurgitation) (p < 0.05).
In multivariable analysis, reverse remodeling of the right atrium and/or left atrium was exclusively correlated with the intervention (cardioversion and/or ablation) during the 12-month follow-up.
Conclusions Treatment of AF should focus on restoration of sinus rhythm to induce reverse remodeling of the anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chamber) cardiac chamber and reduce the severity of functional regurgitation. |
