Study objectives: To evaluate the benefit of sinus
rhythm (SR) restoration in patients with chronic controlled atrial
fibrillation (AF) and left ventricular systolic dysfunction
Design: Prospective case-control study on the
short-term outcome (6 to 9 months) of clinical and echocardiographic
variables following attempted cardioversion.
Outpatient clinic of a university hospital.
Fifteen men and 5 women, ranging in age from 40 to 76 years, who had
chronic controlled (mean [± SD] ventricular rate, 82 ± 10
beats/min) AF and left ventricular fractional shortening (LVFS) of< 28% at baseline. Control was provided by retrospective paired
echocardiographic examinations of six AF patients, plus the study cases
with potentially unsuccessful cardioversion or early recurrence of
Interventions: Attempt to restore SR with
amiodarone or electrical countershock.
results: Conversion was attained in 17 patients, but AF recurred
early in 4 patients, 3 of whom had proven ischemic LVSD. In the 13
patients with sustained SR, LVFS increased from 20 ± 4% to
31 ± 6% (p < 0.0001). In contrast, no changes were detected in
the control group (n = 13). This improvement was paralleled by
decreases in left ventricular (LV) end-diastolic dimension (from
55 ± 7 to 51 ± 6 mm; p = 0.014), LV mass (from 181 ± 28 to
159 ± 37 g; p = 0.015), and left atrial diameter (from 45 ± 9
mm to 42 ± 7; p = 0.003). A marked decrease in heart rate (from
82 ± 9 to 64 ± 5 beats/min; p < 0.0001) and a reduction in New
York Heart Association functional class (from 2.3 ± 0.9 to
1.2 ± 0.4; p = 0.0007) also were observed in patients with
sustained SR but not among subjects in the control group.
Conclusions: Even when adequate control of the ventricular
rate has been achieved, the LV function of patients with chronic AF
greatly improves after restoration and maintenance of