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Rapid Communication| Volume 91, ISSUE 12, P1478-1481, June 15, 2003

Left atrial size and function after spontaneous cardioversion of atrial fibrillation and their relation to n-terminal atrial natriuretic peptide

DOI:https://doi.org/10.1016/S0002-9149(03)00404-1
Left atrial size and function after spontaneous cardioversion of atrial fibrillation and their relation to n-terminal atrial natriuretic peptide
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      Left atrial (LA) stunning after cardioversion of atrial fibrillation (AF) has been reported during spontaneous conversion to sinus rhythm.
      • Khan I.A.
      Transient atrial mechanical dysfunction (stunning) after cardioversion of atrial fibrillation and flutter.
      Am Heart J. 2002; 144: 11-22
      This observation suggest that atrial stunning is a function of underlying arrhythmia and not of the mode of cardioversion. It is known that AF causes atrial dilation, and progressive LA enlargement occurs when AF becomes chronic.
      • Sanfilippo A.J.
      • Abascal V.M.
      • Sheehan M.
      • Oertel L.B.
      • Harrigan P.
      • Hughes R.A.
      • Weyman A.E.
      Atrial enlargment as a consequence of atrial fibrillation. A prospective echocardiographic study.
      Circulation. 1990; 82: 792-797
      Recently, it has been shown that multiple factors contribute to LA enlargement, including the presence and persistence of arrhythmia.
      • Dittrich H.C.
      • Pearce L.A.
      • Asinger R.W.
      • McBride R.
      • Webel R.
      • Zabalgoitia M.
      • Pennock G.D.
      • Safford R.E.
      • Rothbart R.M.
      • Halperin J.L.
      • Hart R.G.
      on behalf of the Stroke Prevention in Atrial Fibrillation Investigators. Left atrial diameter in nonvalvular atrial fibrillation an echocardiographic study.
      Am Heart J. 1999; 137: 494-499
      Many reports suggest that if sinus rhythm is restored then dilation may regress.
      • Welikovitch L.
      • Lafreniere G.
      • Burggraf G.W.
      • Sanfilippo A.J.
      Change in atrial volume following restoration of sinus rhythm in patients with atrial fibrillation a prospective echocardiographic study.
      Can J Cardiol. 1994; 10: 993-996
      The Framingham Study showed a relation between LA size and the risk of stroke in men and the risk of death in both genders.
      The Stroke Prevention in Atrial Fibrillation Investigators
      Predictors of thromboembolism in atrial fibrillation. Echocardiographic features of patients at risk.
      Ann Intern Med. 1992; 116: 6-12
      ,
      • Benjamin E.J.
      • D’Agostino R.B.
      • Belanger A.J.
      • Wolf P.A.
      • Levy D.
      Left atrial size and the risk of stroke and death. The Framingham Heart Study.
      Circulation. 1995; 92: 835-841
      ,
      • Caplan L.R.
      • D’Cruz I.
      • Hier D.B.
      • Reddy H.
      • Shah S.
      Atrial size, atrial fibrillation and stroke.
      Ann Neurol. 1986; 19: 158-161
      Previous studies have suggested that n-terminal atrial natriuretic peptide (N-ANP) levels are elevated in patients with AF.
      • Rossi A.
      • Enriquez-Sarano M.
      • Burnett Jr, J.C.
      • Lerman A.
      • Abel M.D.
      • Seward J.B.
      Natriuretic peptide levels in atrial fibrillation. A prospective hormonal and Doppler-echocardiographic study.
      J Am Coll Cardiol. 2000; 35: 1256-1262
      ,
      • Berglund H.
      • Boukter S.
      • Theodorsson E.
      • Vallin H.
      • Edhag O.
      Raised plasma concentrations of atrial natriuretic peptide are independent of left atrial dimensions in patients with chronic atrial fibrillation.
      Br Heart J. 1990; 64: 9-13
      It is unclear whether AF rather than LA dilation,
      • Globits S.
      • Frank H.
      • Pacher B.
      • Huelsmann M.
      • Ogris E.
      • Pacher R.
      Atrial natriuretic peptide release is more dependent on atrial filling volume than on filling pressure in chronic congestive heart failure.
      Am Heart J. 1998; 135: 592-597
      hemodynamic impairment,
      • Hornestam B.
      • Hall C.
      • Held P.
      • Carlsson T.
      • Falk L.
      • Karlson B.W.
      • Lundstrom T.
      • Peterson M.
      N-terminal proANF in acute atrial fibrillation a biochemical marker of atrial pressures but not a predictor for conversion to sinus rhythm.
      Am Heart J. 1998; 135: 1040-1047
      or another hormonal alteration, can result in the elevation of N-ANP levels.
      • Rossi A.
      • Enriquez-Sarano M.
      • Burnett Jr, J.C.
      • Lerman A.
      • Abel M.D.
      • Seward J.B.
      Natriuretic peptide levels in atrial fibrillation. A prospective hormonal and Doppler-echocardiographic study.
      J Am Coll Cardiol. 2000; 35: 1256-1262
      The present report evaluates the changes in LA size and function after spontaneous cardioversion of AF and their relation to N-ANP.
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      References

        • Khan I.A.
        Transient atrial mechanical dysfunction (stunning) after cardioversion of atrial fibrillation and flutter.
        Am Heart J. 2002; 144: 11-22
        View in Article
        • Sanfilippo A.J.
        • Abascal V.M.
        • Sheehan M.
        • Oertel L.B.
        • Harrigan P.
        • Hughes R.A.
        • Weyman A.E.
        Atrial enlargment as a consequence of atrial fibrillation. A prospective echocardiographic study.
        Circulation. 1990; 82: 792-797
        View in Article
        • Dittrich H.C.
        • Pearce L.A.
        • Asinger R.W.
        • McBride R.
        • Webel R.
        • Zabalgoitia M.
        • Pennock G.D.
        • Safford R.E.
        • Rothbart R.M.
        • Halperin J.L.
        • Hart R.G.
        on behalf of the Stroke Prevention in Atrial Fibrillation Investigators. Left atrial diameter in nonvalvular atrial fibrillation.
        Am Heart J. 1999; 137: 494-499
        View in Article
        • Welikovitch L.
        • Lafreniere G.
        • Burggraf G.W.
        • Sanfilippo A.J.
        Change in atrial volume following restoration of sinus rhythm in patients with atrial fibrillation.
        Can J Cardiol. 1994; 10: 993-996
        View in Article
        • The Stroke Prevention in Atrial Fibrillation Investigators
        Predictors of thromboembolism in atrial fibrillation. Echocardiographic features of patients at risk.
        Ann Intern Med. 1992; 116: 6-12
        View in Article
        • Benjamin E.J.
        • D’Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        • Levy D.
        Left atrial size and the risk of stroke and death. The Framingham Heart Study.
        Circulation. 1995; 92: 835-841
        View in Article
        • Caplan L.R.
        • D’Cruz I.
        • Hier D.B.
        • Reddy H.
        • Shah S.
        Atrial size, atrial fibrillation and stroke.
        Ann Neurol. 1986; 19: 158-161
        View in Article
        • Rossi A.
        • Enriquez-Sarano M.
        • Burnett Jr, J.C.
        • Lerman A.
        • Abel M.D.
        • Seward J.B.
        Natriuretic peptide levels in atrial fibrillation. A prospective hormonal and Doppler-echocardiographic study.
        J Am Coll Cardiol. 2000; 35: 1256-1262
        View in Article
        • Berglund H.
        • Boukter S.
        • Theodorsson E.
        • Vallin H.
        • Edhag O.
        Raised plasma concentrations of atrial natriuretic peptide are independent of left atrial dimensions in patients with chronic atrial fibrillation.
        Br Heart J. 1990; 64: 9-13
        View in Article
        • Globits S.
        • Frank H.
        • Pacher B.
        • Huelsmann M.
        • Ogris E.
        • Pacher R.
        Atrial natriuretic peptide release is more dependent on atrial filling volume than on filling pressure in chronic congestive heart failure.
        Am Heart J. 1998; 135: 592-597
        View in Article
        • Hornestam B.
        • Hall C.
        • Held P.
        • Carlsson T.
        • Falk L.
        • Karlson B.W.
        • Lundstrom T.
        • Peterson M.
        N-terminal proANF in acute atrial fibrillation.
        Am Heart J. 1998; 135: 1040-1047
        View in Article
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      Article info

      Publication history

      Accepted: March 3, 2003
      Received in revised form: March 3, 2003
      Received: December 17, 2002

      Identification

      DOI: https://doi.org/10.1016/S0002-9149(03)00404-1

      Copyright

      © 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.

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