Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Increase in radionuclide left ventricular ejection fraction after eardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy
*Division of Cardiology, CHU Hautepierre Strasbourg, France
Division of Nuclear Medicine, CHU Hautepierre Strasbourg, France
Received 5 March 1991; revised 2 September 1991; .
Correspondence. A Sacrez, MD, Division of Cardiology, CHU Haulepierre avenue Moli.ère. 67200 Strasbourg, France
Abstract
To assess the potential improvement in left ventricular ejection fraction after cardioversion of chronic atrial fibrillation to sinus rhythm in idiopathic dilated cardiomyopathy, we studied prospectively 17 patients, aged 58 ±6 years, by radionuclide angiocardiography at rest.
Left ventricular ejection fraction was determined before treatment and at a mean delay of 4·7 months after eardioversion. Return to sinus rhythm was obtained in 12 patients, pharmacologically or by electrical eardioversion. Five patients remained in atrial fibrillation. No clinical, echocardiographic or haemodynamic finding could predict the success of eardioversion.
In chronic atrial fibrillation, the ejection fraction did not change significantly: 30·0 ± 9·1% (19 to 44%) at the first evaluation and 29·5±8·3% (22 to 41%) after 4·7 months.
After successful eardioversion, left ventricular ejection fraction improved from 32·1 ± 5·3% (24 to 41%) to 52·9 ± 9· 7% (37 to 71%) (P<0·001). The difference was 20·8±l 1·3% and left ventricular ejection fraction was normalized in 50% (6/12) of the patients. There was a significant reduction in the cardiothoracic ratio on chest X-rays and of the left ventricular end-diastolic diameter on echocardiography; fractional shortening increased (27·7 ±4·3% vs 20· 3 ± 2·7%, P <0·01).
A third evaluation was realized after a mean delay of 11·7 months in the patients with successful eardioversion. Sinus rhvthm was present in 83% (10/12) of the patients: seven patients were reevaluated by radionuclide angiography. The improvement in left ventricular function observed at the 4·7 months evaluation was still present. In two patients with recurrence of atrial fibrillation, there was a severe deterioration of left ventricular systolic function.
We conclude that, in idiopathic dilated cardiomyopathy, left ventricular ejection fraction can be increased substantially after eardioversion of chronic atrial fibrillation to sinus rhythm.
Key Words: Left ventricular ejection fraction • atrial fibrillation • idiopathic dilated cardiomyopathy • eardioversion • radionuclide angiocardiography
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