Predicting Early Atrial Fibrillation Recurrence Post-Electrical Cardioversion: A Critical Look at Bilateral Atrial Function

Background/Objectives: The recurrence rate of atrial fibrillation (AF) after electrical cardioversion (ECV) appears to correlate with morpho-functional changes in both the left (LA) and right atria (RA). The present study focuses on identifying predictors for AF recurrence post-ECV. Methods: Sixty-one patients were included in the study following an elective ECV with a successful conversion to SR, and were subjected to cardiovascular assessment immediately after ECV. Results: At 6-month follow-up, 24 patients (39.3%) experienced AF recurrence. Patients without AF recurrence showed a lower right atrial valvular index (RAVi) (32 ± 8 vs. 40 ± 10 mL/m2, p = 0.03), a higher LA strain S-R (15.8 ± 7.7 vs. 9.0 ± 4.2%, p = 0.003), and more pronounced lateral a’ wave (5 ± 3 vs. 3 ± 1 m/s, p = 0.01), tricuspid a’ wave (7 ± 3 vs. 4 ± 2 m/s, p = 0.02), average a’ wave (6 ± 2 vs. 3 ± 1, p = 0.005), and augmentation index corrected for 75 beats per minute (Aix75) (26 ± 13 vs. 37 ± 12, p = 0.01). Based on these results, patients were assigned one point for each of the following criteria: RAVi > 36 mL/m2, average a’ wave > 4, LA strain S-R > 13%. The ROC curve analysis showed that a score of 3 had an AUC for AF recurrence of 0.81 (p < 0.001, CI 0.69–0.91), with a sensitivity of 96% and a specificity of 62%. Conclusions: LA strain, TDI Doppler, RAVi, and Aix75 measured immediately post-ECV were independent predictors of AF recurrence after ECV.