Clinical Research Right Atrial Volume Is Superior to Left Atrial Volume for Prediction of Atrial Fibrillation Recurrence After Direct Current Cardioversion Christina Luong, MD, a Darby J.S. Thompson, PhD, b,c Matthew Bennett, MD, d Kenneth Gin, MD, d John Jue, MD, d Marion E. Barnes, MSc, d Pamela Colley, MN, NP, d and Teresa S.M. Tsang, MD d a Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada b EMMES Canada, Burnaby, British Columbia, Canada c Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada d Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada See editorial by Ng et al., pages 17-19 of this issue. ABSTRACT Background: The value of right atrial volume as a predictor for recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV) is unknown. Methods: We sought to compare the performance of right atrial vol- ume indexed to body surface area (RAVI), left atrial diameter, left atrial volume indexed to body surface area (LAVI), and biatrial volume index (BAVI) for the prediction of AF recurrence at 6 months after DCCV. This study included the first 95 consecutive patients from the AF Clinic at a large tertiary care hospital who underwent DCCV and who had an echocardiogram available within 6 months before DCCV. Maximal LAVI, RAVI, and BAVI were determined from the echocardiogram before DCCV. Electrocardiographic and clinical data were acquired at baseline, before cardioversion, and at each clinic visit. Results: Of the 95 patients (64 male; mean age, 63  12 years), history of systemic hypertension, diabetes mellitus, heart failure, and transient R  ESUM  E Introduction : La valeur du volume auriculaire droit pour pr edire la r ecurrence de la fibrillation auriculaire (FA) après la cardioversion  electrique (CVE) demeure inconnue. M ethodes : Nous avions pour objet de comparer la performance du volume de l’oreillette droite index e à la surface corporelle (VODI), du diamètre de l’oreillette gauche, du volume de l’oreillette gauche index e à la surface corporelle (VOGI) et de l’indice du volume biaur- iculaire (IVBA) pour pr edire la r ecurrence de la FA 6 mois après la CVE. Cette  etude incluait les 95 premiers patients cons ecutifs de la clinique de FA d’un grand hôpital de soins tertiaires qui subissaient la CVE et qui avaient un  echocardiogramme disponible dans les 6 mois pr ec edant la CVE. Le VOGI, le VODI et l’IVBA maximaux  etaient d etermin es d’après l’ echocardiogramme avant la CVE. Les donn ees  electrocardiographiques et cliniques  etaient recueillies au d ebut, avant la cardioversion et à chaque consultation. Atrial fibrillation (AF) is epidemic. 1 It is the most common arrhythmia and occurs in approximately 1%-2% of the gen- eral population, affecting 6% of those older than the age of 65 years. 2 In addition to much-feared consequences of stroke, 3 heart failure, 4,5 and cognitive dysfunction, 6,7 up to nearly 90% of the patients with AF are symptomatic. 8,9 In the management of AF patients, the goals include stroke pre- vention and arrhythmia management (rate vs rhythm control). Rhythm control is often selected when patients have signifi- cant symptom burden. Direct current cardioversion (DCCV) aims to restore sinus rhythm (SR) in persistent AF. AF is associated with electrical and structural remodelling, including fibrosis and enlargement of the left and right atrium. 10-14 The larger the left atrium, the higher the risk for recurrence of AF. Increased left atrial (LA) diameter (LAd), LA area, and LA volume have been confirmed to predict recurrence of AF after cardioversion. 15-20 The predictive value of right atrial (RA) area and diameter, indexed to body surface area, for such prediction was assessed only in 1 study. 21 To the best of our knowledge, no study has evaluated RA volume for prediction of Canadian Journal of Cardiology 31 (2015) 29e35 Received for publication January 28, 2014. Accepted October 8, 2014. Corresponding author: Dr Teresa S.M. Tsang, University of British Columbia, Diamond Health Care Centre 9th Floor Cardiology, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada. Tel.: þ1-604-875- 5067; fax: þ1-604-875-8290. E-mail: t.tsang@ubc.ca See page 33 for disclosure information. http://dx.doi.org/10.1016/j.cjca.2014.10.009 0828-282X/Ó 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.