International Journal of Statistics in Medical Research, 2019, 8, 51-56 51 E-ISSN: 1929-6029/19 © 2019 Lifescience Global Troubles of Atrial Mechanical Recovery after Electrical Cardioversion in Patients with Persistent or Long-Lasting Persistent Atrial Fibrillation Renato De Vecchis 1,* , Andrea Paccone 2 and Marco Di Maio 3 1 Preventive Cardiology and Rehabilitation Unit, DSB 29 “S.Gennaro dei Poveri Hospital”, via S.Gennaro dei Poveri 25, 80136 Naples, Italy 2 Department of Cardiology, University of Bari “Aldo Moro”, Bari, Italy 3 Department of Cardiology, University of Campania” Luigi Vanvitelli”, 80138 Naples, Italy Abstract: Background: In the present retrospective cohort study we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent atrial fibrillation (AF) who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV). Methods: The endpoint of our study was the failure to recover the normal mechanics of the left atrium. Inclusion criterion was the persistent or long-lasting persistent AF successfully treated by means of ECV, provided that a pertinent documentation was made available, comprising ECG, conventional 2D echo-color-Doppler and speckle tracking echocardiography(STE) evaluation, with also a STE assessment of the atria at the days 1, 30 and 90 from the ECV freely available within the clinical record of the patient. Results: Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as 22.5% of them did not achieve the normalization of their atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV. The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The values of 18% and 17% were also calculated to serve as cut off values, respectively, for the risk of atrial mechanical dysfunction and for the risk of AF relapses over a 12 month follow-up. Conclusions: Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long –standing persistent AF.In this case a serial STE evaluation could be useful to evaluate the atrial hypofunction over time. Keywords: Atrial fibrillation, electrical cardioversion, atrial mechanical recovery, speckle tracking echocardiography, outcome. INTRODUCTION If atrial fibrillation (AF) persists for a long time - for more than 48 hours, persistent AF, or for more than twelve months, long-lasting persistent AF - the method adopted for converting AF to sinus rhythm is usually the ECV, although, in the most of the dedicated centers, an initial attempt at pharmacological cardioversion with the use of intravenous amiodarone or propafenone is generally implemented [1]. Unlike recent onset atrial fibrillation (≤ 48 hours, paroxysmal AF), the persistent or long-lasting persistent AF requires a minimum period of three weeks of full anticoagulation, carried out by means of warfarin, in the case of valvular AF, i.e., associated with mitral stenosis or mitral prosthesis, or, in the case of non-valvular AF, carried out by means of a non- vitamin K antagonist oral anticoagulant. *Address correspondence to this author at the Preventive Cardiology & Rehabilitation Unit, DSB 29 “S.Gennaro dei Poveri Hospital”, via S.Gennaro dei Poveri 25, 80136 Napoli, Italy; Tel: +390817516932; Mob: +393483313530; E-mail: devecchis.erre@virgilio.it A not completely clarified issue is the fact that a post-cardioversion very prolonged stunning might take place in a certain number of patients. In the case of persistent or long- lasting persistent AF, it is well- known that an atrial both anatomic and electrical remodeling takes place usually. Moreover, in the patients converted to sinus rhythm, it is known that a certain timeframe has to pass before this unfavorable remodeling can regress or disappear. In short, in the period immediately following the ECV, a reduction of global atrial strain(GSA +) in the reservoir phase of the atrial cardiac cycle is detected usually using speckle tracking echocardiography( STE). The acronym adopted is GSA +, which stands for global strain of the left atrium, while the sign + represents the percentage increase in left atrial volume that occurs at this stage. In patients with persistent AF or long- lasting persistent AF, low values of GSA+, detected at the hours immediately subsequent to the ECV, are a relatively frequent finding [2]. Moreover, in about 75% of patients, there is a recovery of the atrial global strain over the course of the days, with