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

      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.
      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.
      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.
      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.
      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.
      ,
      • 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.
      ,
      • Caplan L.R.
      • D’Cruz I.
      • Hier D.B.
      • Reddy H.
      • Shah S.
      Atrial size, atrial fibrillation and stroke.
      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.
      ,
      • 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.
      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.
      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.
      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.
      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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