[The influence of electrical cardioversion on left ventricular systolic function, left atrial size, ANP levels and enzymatic activity of CPK and CD-MB in serum of patients with paroxysmal atrial fibrillation].

OBJECTIVE

To estimate the influence of electrical cardioversion on the left ventricular systolic function, left atrial size, the plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB) and plasma level of atrial natriuretic peptide (ANP) in patients with paroxysmal atrial fibrillation caused by coronary artery disease, hypertension or mitral valve disease.

PATIENTS

The study underwent 36 patients with paroxysmal atrial fibrillation of mean duration 24.5 hours in which sinus rhythm was restored by electrical cardioversion.

METHODS

Plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB), plasma level of atrial natriuretic peptide (ANP) and echocardiographic examination were obtained before and 24 hour after electrical cardioversion. During echocardiographic examination were measured left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left atrial size (LA) and early diastolic velocity(E) and velocity with atrial contraction (A) of left ventricular inflow. Electrical cardioversion was initiated with impulse of 100 J. If it failed to convert atrial fibrillation to sinus rhythm next impulse of 200 J and 360 J were consequently applied.

RESULTS

In all subgroups of patients formed dependently on a number of electrical shocks, 24 hour after cardioversion significant increase in left ventricular ejection fraction (LVEF) and decrease in plasma level of ANP were noted. In subgroup of patients treated with 1 (100 J) and 2 (100 + 200 J) impulse significant decrease in left atrial size was found out. The increase in plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB) was confined to the subgroup treated with 3 (100 + 200 + 360 J) impulses. No changes in left ventricular end diastolic diameter (LVEDD) and early velocity (E) of left ventricular inflow 24 hours after cardioversion were observed. In all patients electrical cardioversion brought about the appearance of atrial wave of left ventricular inflow. No differences in estimated parameters between patients with coronary artery disease, hypertension and mitral valve disease were observed. Significant positive correlation between plasma level of ANP and left atrial size before (r = 0.69, p < 0.001) and after cardioversion (r = 0.68, p < 0.0001) were found.

CONCLUSIONS

Restoration of the sinus rhythm in patients with paroxysmal atrial fibrillation leads to the increase in left ventricular ejection fraction (LVEF) and to the decrease in left atrial size (LA) and the plasma level of atrial natriuretic peptide. Left atrial size and plasma level of ANP are related. The cardioversion with impulses of high energy increases the plasma activity of creatinine phosphokinase and its myocardial fraction.