Left ventricular diastolic function after electrical cardioversion of atrial fibrillation

In chronic atrial fibrillation (AF) left ventricular function may gradually diminish as a result of an intrinsic tachycardiomyopathy.1 This tachycardia induced cardiomyopathy is characterised by decreased systolic function, ventricular dilation, and raised ventricular filling pressures. In such patients left ventricular systolic function may gradually improve after electrical cardioversion.1 Little is known about left ventricular diastolic function in AF. In animal models with chronic rapid pacing induced cardiomyopathy, systolic dysfunction is accompanied by an increased diastolic wall stress and impaired myocardial relaxation.2 In addition, recovery from supraventricular tachycardia induced cardiomyopathy in animal models is associated with hypertrophy, reduced myocardial blood flow, and diastolic dysfunction.3 Whether the same changes in diastolic left ventricular function hold true for humans with AF remains to be investigated. The present study was performed to investigate diastolic filling in patients with AF after successful cardioversion compared to a control group. Seventeen patients who had successfully undergone direct current electrical cardioversion for persistent lone AF or atrial flutter were studied. Lone AF was diagnosed when the absence of hypertension, significant valvar disease, coronary artery disease, hyperthyroidism or other cardiovascular disease could be established. Informed consent was given by all patients. Oral anticoagulation was instituted. Rate controlling drug treatment and antiarrhythmic drug therapy was instituted singly or in combination. Direct …