Role of Echocardiography in the Management of Atrial Fibrillation Patients

Atrial fibrillation (AF) is the most common arrhythmia in adults, with a prevalence that increases from less than 1% in subjects aged below 60 years to more than 9% in those over 80 years old [1]. In recent years new and potentially curative therapeutic approaches have been developed [1]. Today, the role of echocardiography is very important in the assessment of the morphology and functionality of cardiac structures, risk stratification, and in guiding the management of AF. The guidelines consider two-dimensional transthoracic echocardiography (TTE) to be essential for the routine evaluation of patients with AF [2]. TTE should be performed in all AF patients to determine left atrial (LA) and left ventricular (LV) dimensions and LV wall thickness and function, and to recognise important underlying pathological conditions. TTE allows the identification of a possible aetiology of the FA, and the exclusion of occult valvular (particularly rheumatic mitral stenosis), myocardial, or pericardial disease. Lone AF, especially in young subjects, suggests a triggered mechanism that may be amenable to radiofrequency ablation. Abnormal myocardial LV relaxation is detectable from tissue Doppler imaging on the basis of reduced early diastolic mitral annular velocity or a reduced velocity of early mitral flow propagation [3]. The LA dimensions correlate with the probability of successful cardioversion and sinus rhythm maintenance. The anteroposterior LA dimension is usually calculated in the two-dimensional short axis view from M-mode imaging, while LA area or volume can be easily measured in four-chamber and two-chamber views from the apical approach. When the anteroposterior diameter of the left atrium is more than 45 mm, the likelihood of success in the maintenance of sinus rhythm after cardioversion is generally poor. It has