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PubMed1991

Mechanism of augmented left atrial pump function in myocardial infarction and essential hypertension evaluated by left atrial pressure-dimension relation.

To analyze left atrial (LA) pump function in normal subjects, in patients with essential hypertension and in patients with a healed myocardial infarction, LA dimension (aortic-root echogram) and pressure (catheter-tip manometer) were simultaneously recorded in 25 patients (8 normal subjects, 7 with hypertension and 10 with myocardial infarction). The pressure-dimension relation of the left atrium was composed of 2 loops: the A loop (expressing the pump function of the left atrium) and the V loop. LA dimension at the beginning of active LA shortening was significantly greater in hypertensive subjects (33 +/- 3 mm) and in those with myocardial infarction (32 +/- 4 mm) than in normal subjects (28 +/- 3 mm) (p less than 0.01, p less than 0.05, respectively). The area of the A loop significantly increased in subjects with hypertension (48 +/- 3 mm Hg.mm, p less than 0.01) and in subjects with myocardial infarction (29 +/- 10 mm Hg.mm, p less than 0.05), compared with normal subjects (20 +/- 8 mm Hg.mm). The mean fractional shortening velocity of the left atrium significantly increased in subjects with hypertension, compared with normal subjects and those with myocardial infarction (p less than 0.05 for both). LA peak wall tension during the LA active contraction period significantly increased with hypertension and with myocardial infarction, compared with normal subjects (p less than 0.01, p less than 0.05, respectively). The area of the A loop was directly proportional to the LA dimension at the beginning of active LA shortening (r = 0.53), p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Maintenance of sinus rhythm and recovery of atrial mechanical function after cardioversion with bepridil or in combination with aprindine in long-lasting persistent atrial fibrillation.

BACKGROUND: The aim of this study was to evaluate pharmacological cardioversion of long-lasting persistent atrial fibrillation (AF) using bepridil in terms of recovery of atrial mechanical function and maintenance of sinus rhythm. Bepridil alone or in combination with aprindine is effective for termination of persistent AF. METHODS AND RESULTS: The study group comprised 38 consecutive patients (24 men, 58.8+/-9.3 years) with successful conversion of persistent AF lasting >1 month either pharmacologically (Group I) or electrically (Group II). Fast Fourier transform analysis of fibrillation waves was performed and fibrillation cycle length (FCL) was calculated from the peak frequency. In Group I, sinus rhythm was pharmacologically restored in 22 patients after an average 30 days (7-49 days) of bepridil administration, either alone (11) or in combination with oral aprindine (11); they were followed up while using the same drugs. In Group II, electrical conversion restored sinus rhythm in 16 patients, and they were followed up with conventional antiarrhythmic drugs other than bepridil and aprindine. After bepridil treatment FCL increased and became significantly longer in Group I than in Group II (190+/-39 vs 150+/-29 ms, p<0.001). Atrial peak velocity in transmitral flow within the first week after cardioversion was greater in Group I than in Group II (68+/-35 vs 32+/-20 cm/s, p<0.05). By Kaplan-Meier analysis, 83% of Group I patients were free of AF recurrence at the 12-month follow-up, compared with 36% in Group II (p<0.005). CONCLUSIONS: In patients with long-lasting AF, pharmacological conversion with bepridil alone or in combination with aprindine recovered atrial mechanical function better and maintained sinus rhythm longer than electrical conversion.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

[Endocrine function of the heart. Structure and biological properties of peptides secreted by the heart atrium].

Apart from the generally known functions, the heart has also an endocrine function. Atrial cardiocytes, being typical secretory cells, release peptide hormones into the blood stream: atrial natriuretic peptide containing 28 amino acids and cardiodilatin. The structure of atrial peptides was determined. It was shown that both peptides were derived from their common precursor, a protein containing 151 amino acids. The presence of specific receptors is demonstrated on plasmatic membranes of cells of kidney epithelium, arterial smooth muscle, arterial endothelium, kidney cortex and hypophysis. The interaction of atrial peptides with these receptors activates the guanylate cyclase system. The biological action of atrial peptides manifests itself in the quick, massive and instantaneous increase of diuresis and electrolyte excretion, elevated clearance of creatinine, decrease of kidney vascular resistance, intensification of glomerular filtration, inhibition of stimulated secretion of aldosterone, relaxation of blood vessels, elimination of arterial and intestinal spasm induced by various endogenous and exogenous vasoconstrictors and in correction of kidney hypertension. Various radioimmunoassays for the presence of atrial peptides in human plasma were developed; it was shown that in patients with congestive heart failure the content of atrial peptides is increased.

Amino Acid Sequence↗
PubMed1985

The role of the atria in fluid volume control.

Neural reflexes from the heart, in particular the atria, are well documented and are involved in sodium and water excretion. Current work also indicates that the atria have an important endocrine function. Atrial peptides, which have been recently characterized and synthesized, may play a significant role in the homeostasis of body fluids.

Animals↗
PubMed2003

Left atrial appendage function and abnormal hypercoagulability in patients with atrial flutter.

STUDY OBJECTIVES: The prevalence of thromboembolism might be higher than previously recognized in patients with atrial flutter (AFL) based on findings of transesophageal echocardiography (TEE). To evaluate the potential prothrombotic state in patients with AFL, TEE findings and hemostatic markers were compared among patient groups with AFL, normal sinus rhythm (NSR) and chronic nonvalvular atrial fibrillation (AF). DESIGN AND SETTINGS: Cross-sectional study at a university hospital. METHODS: In 28 patients (mean age, 63 years) with AFL, 58 patients (mean age, 66 years) with AF, and 27 patients (mean age, 61 years) with NSR who underwent TEE, plasma levels of markers for platelet activity (platelet factor 4 and beta-thromboglobulin [beta-TG]), thrombotic status (thrombin-antithrombin III complex and prothrombin fragments 1 and 2) and fibrinolytic status (d-dimer and plasmin-alpha(2)-plasmin inhibitor complex) were determined. RESULTS: Left atrial appendage (LAA) blood flow velocity in patients with AFL was higher (p < 0.05) than that in patients with AF, but was lower (p < 0.05) than that in patients with NSR (AF, 25 +/- 2; AFL, 44 +/- 4; NSR, 60 +/- 4 cm/s). Dense left atrial spontaneous echo contrast (SEC) was found in 4 patients (14%) with AFL and 16 patients (28%) with AF. There was no significant difference in plasma levels of hemostatic markers between the AFL group and the NSR group. AFL patients with impaired LAA function (LAA flow < 30cm/s, dense SEC, or both), however, showed higher level of d-dimer and beta-TG than those without impaired LAA function (d-dimer, 1.9 +/- 0.6 microg/mL vs 0.4 +/- 0.1 microg/mL; beta-TG, 73 +/- 17 ng/mL vs 33 +/- 5 ng/mL, p < 0.05). CONCLUSIONS: Patients with AFL as a whole are not in the prothrombotic state as compared with those with AF. However, patients with AFL and impaired LAA function are at potentially high risk for thromboembolism and might require anticoagulation.

Aged↗
PubMed1989

Atrial wall function and plasma atriopeptin during volume expansion in conscious dogs.

Mean left atrial pressure is believed to be an accurate estimate of atrial stretch in vivo and is used to assess the stimulus for atriopeptin release in both animals and humans. However, for a number of years it has been known that atrial stretch receptor discharge occurs during specific phases of the atrial cycle and that B-receptor discharge correlates with the passive filling of the atrium, which occurs during the V wave. The purpose of this study was to develop the concept that phase-specific changes in atrial wall stress are responsible for atriopeptin secretion. In chronically instrumented conscious dogs, volume expansion (1,000 ml of saline in 5 min) increased left atrial pressure and dimensions and caused a 663 +/- 189% increase in plasma immunoreactive atriopeptin from 44 pg/ml. At this time, mean left atrial pressure increased only 202 +/- 36% (mean +/- SE), whereas A wave pressure increased 146 +/- 19% and V wave pressure increased 290 +/- 67%. A and V wave dimensions increased only a few percent. After developing atrial wall thickness constants for diastole (KCl fixation) and systole (BaCl2 fixation), calculated atrial A wave wall stress increased 163 +/- 25%, and V wave wall stress increased 346 +/- 85%. Minute wall stress (wall stress times heart rate) gave an even better correlation with changes in plasma atriopeptin. V wave minute wall stress increased 690 +/- 168%, whereas A wave wall stress increased 366 +/- 56%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1998

Left atrial and left atrial appendage functional abnormalities in patients with cardioembolic stroke in sinus rhythm and idiopathic atrial fibrillation.

Thrombogenesis in the left atrial appendage (LAA) has been related to the special morphology of this cavity and to its size and degree of dysfunction. However, no study has focused on LAA function in conjunction with left atrial (LA) function in both sinus rhythm (SR) and nonrheumatic idiopathic atrial fibrillation (AF) in relation to clinical status (cardioembolic stroke). Forty-three patients in SR (14 patients with stroke, 29 control subjects) and 45 patients in AF (27 patients with stroke, 18 control subjects) were examined by transthoracic and transesophageal echocardiography. Baseline clinical characteristics and standard transthoracic and transesophageal measurements of the LA and LAA (size, fractional area change, flow measurements, spontaneous echo contrast, and thrombus) were recorded and compared in relation to cardiac rhythm. Patients in the stroke-SR group showed a significant decrease of fractional area change in the LA (32%+/-15%) and LAA (34%+/-15%) in relation to control subjects (43%+/-10%, p = 0.035, 49%+/-13%, p = 0.006, respectively). Patients in the stroke-AF group showed significant reduction of appendage flow measurements (outward velocity = 22+/-13 vs 33+/-19 cm/sec, p = 0.036), whereas no differences were detected in the center of the LA. In multiple regression analysis, the presence of cardioembolic stroke was positively associated with the presence of spontaneous echo contrast (p = 0.0253) and spontaneous echo contrast negatively associated with appendage inward flow velocity (p<0.001). Cardioembolic stroke in patients in SR is associated with a global decrease of shortening in both cavities and in patients with AF, with a reduction of LAA flow parameters. Patients with spontaneous echo contrast, thrombus, or both showed further reduction of shortening and flow velocities in both cavities, indicating a more advanced stage of dysfunction.

Aged↗
PubMed1998

Left atrial appendage function assessed by transesophageal echocardiography before and on the day after elective cardioversion for nonvalvular atrial fibrillation.

We investigated left atrial appendage function by transesophageal echocardiography, on the day after external electrical cardioversion to sinus rhythm, in 41 patients with nonvalvular atrial fibrillation. After cardioversion, appendage contraction synchronized with the electrical and mechanical activity of the atrium, which was restored in about 70% of the patients.

Adult↗
PubMed1998

Severely reduced left atrial appendage function: a cause of embolic stroke in patients in sinus rhythm?

Recently, attention has been focused on transesophageal echocardiographic detection of left atrial appendage function to assess of risk of thrombus formation because of potential benefit of anticoagulation therapy. However, most of these studies have been conducted in patients with atrial fibrillation or mitral valve disease. In this article we review cases of 2 patients without valvular disease who had embolic stroke in sinus rhythm. Transesophageal echocardiography revealed thrombi in the left atrial appendage in both patients. The left atrial appendage function in these patients was compared with that in patients with chronic atrial fibrillation and a control group in sinus rhythm. Left atrial appendage function in the patients with stroke and sinus rhythm was significantly lower than that of patients in the control group in sinus rhythm (P < .001) and was similar to the appendage function in patients with chronic atrial fibrillation. These observations provide further evidence that the finding of reduced left atrial appendage function can be a cause of stroke in patients with sinus rhythm even in the absence of mitral valve disease. Reduced left atrial appendage function may identify patients with unexplained stroke who should receive anticoagulation therapy even in the absence of detectable appendage thrombi.

Adult↗
PubMed1998

Restoration of atrial mechanical function after maze operation in patients with structural heart disease.

BACKGROUND: The maze operation is effective for the restoration of sinus rhythm; however, restoration of atrial mechanical function has not been demonstrated in all patients. METHODS: Maze operations were performed in 32 patients (13 men, 19 women; mean age 47.1 +/- 9.0 years) combined with valvular surgery (n = 25), coronary artery bypass graft (CABG) (n = 3), and others (n = 4). At 1 week, 3 months, 6 months, and 1 year after the operation, prospective serial Doppler echocardiographic examination was carried out to determine the presence of atrial mechanical function. RESULTS: Sinus rhythm was restored and maintained during the follow-up period in 26 (81%) patients; in 22 patients this was due solely to the operation, whereas in four patients an antiarrhythmic agent was needed to maintain sinus rhythm. Another four patients showed paroxysmal atrial fibrillation (AF) despite treatment with an antiarrhythmic agent. Right atrial mechanical function was restored in all 30 patients with sinus rhythm or paroxysmal AF; in 19 (63%) of these, left atrial mechanical function was restored. In patients with restored left atrial mechanical function, peak A velocity (A) and A/E ratio (A/E) of mitral inflow were significantly lower than in the 16 postoperative control patients (A: 0.46 +/- 0.14 m/sec vs 0. 75 +/- 0.29 m/sec, p < 0.01; A/E: 0.40 vs 0.80, p < 0.01). In patients with left atrial mechanical function, the duration of AF was significantly shorter than in patients without left atrial mechanical function (1.9 +/- 2.9 years vs 7.1 +/- 3.0 years, p < 0. 01), but there were no significant differences in left atrial size and volume. CONCLUSIONS: The maze operation could be safely added to standard open heart surgery for the correction of underlying structural heart disease. The rate of conversion to sinus rhythm resulting solely from the operation might be lower than the rates previously reported with only the duration of AF adversely affecting the restoration of left atrial mechanical function. Considering the fact that not all patients converted to sinus rhythm show atrial mechanical function, the role of the maze operation in the prevention of systemic embolism, with subsequent improvement in survival, requires further study.

Adult↗
PubMed2000

Noninvasive indexes of left atrial diastolic function in hypertrophic cardiomyopathy.

OBJECTIVES: Our goal was to noninvasively assess left atrial diastolic function and its relation to the impaired left ventricular filling in patients with hypertrophic cardiomyopathy. METHODS AND RESULTS: We studied 34 patients with hypertrophic cardiomyopathy, 26 patients with secondary forms of left ventricular hypertrophy (aortic stenosis, fixed subaortic stenosis, hypertension), and 21 control subjects. Left atrial diastolic function was assessed by measuring acceleration time (SAT), deceleration time (SDT), and the EF (mean deceleration rate) slope of the pulmonary venous flow systolic wave (SW). Left ventricular diastolic function assessed by transmitral Doppler included peak early left ventricular and peak atrial filling velocities, the ratio of early-to-late peak velocities, isovolumic relaxation time, deceleration time, and EF slope. In patients with hypertrophic cardiomyopathy, acceleration time was significantly reduced (P<.05), deceleration time was significantly prolonged (P<.0001), and EF slope was significantly reduced (P<.01). These indexes were similar among the other two groups. No statistically significant difference existed between the subgroups of hypertrophic cardiomyopathy in the above indexes. Patients with hypertrophic cardiomyopathy and secondary forms of left ventricular hypertrophy had evidence of left ventricular diastolic dysfunction. In patients with hypertrophic cardiomyopathy, no correlation existed between left atrial and left ventricular diastolic function indexes (r = -0.26 to 0.33). CONCLUSIONS: Echocardiographic indexes of left atrial relaxation and filling are abnormal in patients with hypertrophic cardiomyopathy but not in secondary forms of left ventricular hypertrophy. These indexes are abnormal in all forms of hypertrophic cardiomyopathy irrespective of left ventricular outflow tract obstruction and distribution of hypertrophy; they are not solely attributable to left ventricular diastolic dysfunction. The above may imply that hypertrophic cardiomyopathy is a cardiac myopathic disease that involves the heart muscle as a whole, irrespective of distribution of hypertrophy and obstruction.

Adolescent↗
PubMed1996

Transesophageal echocardiographic evaluation of left atrial appendage function and spontaneous contrast formation after chemical or electrical cardioversion of atrial fibrillation.

Changes in left atrial (LA) appendage pulsed-wave Doppler velocities and changes in grades of spontaneous contrast occur immediately after electrical cardioversion of atrial fibrillation (AF) using transesophageal echocardiography (TEE). The effect of sequential ineffective electrical cardioversion attempts or chemical cardioversion on these parameters is unknown. TEE was performed in 23 patients with chronic AF. Doppler velocities and grades of spontaneous contrast were assessed before and after each cardioversion attempt until sinus rhythm was achieved. Doppler emptying and filling velocities were significantly decreased after electrical (0.39 +/- 0.14 vs 0.27 +/- 0.16 [p = 0.01] and 0.43 +/- 0. 18 vs 0.30 +/- 0.14 m/s [p = 0.01]) or chemical cardioversion to sinus rhythm (0.65 +/- 0.18 vs 0.31 +/- 0.06 [p = 0.03] and 0.64 +/- 0.22 vs 0.44 +/- 0.17 m/s [p = 0.04]). Spontaneous contrast developed in 1 of 3 patients after chemical conversion to sinus rhythm and was present in 11 of 20 patients before electrical cardioversion, developing in 4 patients and intensifying in 2 patients immediately after successful cardioversion. These phenomena were not seen after ineffective electrical or chemical cardioversion attempts. This suggests that restoration of sinus rhythm is in itself responsible for these phenomena, not the method by which sinus rhythm is achieved.

Aged↗
PubMed1995

[The rate of recovery of left atrial contractile function after the transition to sinus rhythm in patients with paroxysmal atrial fibrillation].

In the examination of 120 patients without valvular heart disease suffering from atrial fibrillation paroxysms mechanical function of the left atrium (LA) was assessed using Doppler echocardiography. The majority of the examinees had dilated LA which is thought to be arrhythmogenic. The recovery of the sinus rhythm is accompanied by electromechanical dissociation the longest duration of which took place in subjects exposed to electrical defibrillation. An inverse relationship was established between the time of the last fibrillation and recovery of LA mechanical function. The duration of the electromechanical dissociation of the atria holds prognostic importance in relation to recurrent fibrillation.

Adult↗
PubMed2004

The effect of pulmonary hypertension on left atrial mechanical functions in chronic obstructive lung disease.

BACKGROUND: Left atrial (LA) function is an important determinant of left ventricular (LV) filling. However, the effect of pulmonary hypertension (PH) on LA mechanical function in chronic obstructive lung disease (COLD) has not been studied, yet. METHODS: 49 patients with COLD and 25 controls were included in this study. Patients were divided into two subgroups: patients without PH (group 1, n=21) and with PH (group 2, n=28). LA volumes were determined at mitral valve opening (Vmax), at onset of atrial systole (Vp) and at mitral valve closure (Vmin) according to biplane area-length method. The following LA parameters were calculated: passive emptying volume (PEV=Vmax-Vp), conduit volume [CV=LV stroke volume-(Vmax-Vmin)], passive emptying fraction (PEF=PEV/Vmax), active emptying volume (AEV=Vp-Vmin), active emptying fraction (AEF=AEV/Vp), total emptying volume (TEV=Vmax-Vmin), percent contribution of PEV, CV and AEV to LV stroke volume. RESULTS: Vmax (p<0.01), PEV (p<0.001) and TEV (p<0.05) were lower in group 2 than in the controls, and the differences between group 1 and control group were insignificant (p>0.05). Vp, Vmin, CV and AEV did not differ among three groups. Percent contribution to LV filling of the PEV was decreased in group 2 when compared to group 1 (p<0.05) and the controls (p<0.01). Percent contribution to LV filling of the AEV was increased in group 2 when compared to the controls (p<0.05). There were inverse correlations between pulmonary artery pressure and the following parameters: LV stroke volume (r=-0.43, p<0.01), mitral E/A (r=-54, p<0.001), Vmax (r=-0.35, p<0.05), PEV (r=-40, p<0.01) and PEF (r=-0.43, p<0.01). CONCLUSION: This study shows that the alterations of LA mechanical functions in patients with COLD are closely correlated to PH levels. Furthermore, these results underline the importance of maintaining a sinus rhythm in these patients.

Adult↗
PubMed1996

Dependence of atrial sensing function on posture in a single-lead atrial triggered ventricular (VDD) pacemaker.

The influence of body posture on atrial sensing was examined in a single-lead VDD pacemaker in 16 patients. At implantation, a position was searched for the floating atrial bipolar sensor to obtain an adequate atrial signal amplitude. After 1-12 months the atrial signals were measured by programming the sensitivity in five postures: supine, sitting, and standing and lying on the right and left sides. The group mean amplitudes of the atrial signal were equal in all postures, and comparable to the supine value (1.01 +/- 0.51 mV). However, the values within each individual varied considerably according to position, by a range of 0.46 +/- 0.41 mV on average. Testing only supine did not always predict decent sensing when upright, e.g., in 3 patients the atrial signal decreased more than 0.5 mV. In 24-hour ambulatory electrocardiography, with the sensitivity (0.15-0.30 mV) set to cover all postures, atrial beats were undersensed not at all in 4 patients, < 0.01% in 6 patients, and < 0.1% in the remaining 6 patients. Thus, with a floating atrial electrode, sensitivity testing in various postures is advisable to ascertain proper sensing function.

Aged↗
PubMed2003

Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation.

AIMS: We determined late atrial function following a surgical linear endocardial radiofrequency (RF) ablation procedure that aimed to restore and maintain sinus rhythm (SR) in atrial fibrillation (AF). We tested the hypothesis that successful restoration of SR is accompanied by measurable mechanical atrial function that is at normal or near normal levels. METHODS: Forty-seven patients who underwent the surgical RF procedure at least 6 months previously (median 2.86 years; range: 0.6-4.2 years) were studied using an array of echocardiographic variables. Two patient groups (SR restored [RF-SR], persistent AF [RF-AF]) and an age matched control group were studied. Among the echocardiographic variables measured were left atrial (LA) size and volume, LA active fractional emptying and mitral annular displacement corresponding to atrial contraction (A' velocity) by Doppler tissue imaging. RESULTS: At long term follow up 29/47of patients who underwent the RF procedure were in SR with atrial contraction present echocardiographically. Of the patients initially restored to SR, the proportion remaining in SR at 3 years was 79% (SE 9%). The atrial-emptying fraction was reduced in comparison to that seen in normal controls (27+/-14% vs 46+/-10%). The A' velocity was decreased in the surgical RF cohort vs controls (4.4+/-1.3 vs 9.7+/-1.7cm/s; P=0.0001). Despite LA size preoperatively being similar in both surgical groups, atrial size decreased in those in whom SR was restored (48.6+/-7.6 vs 44.8+/-4.7mm; P=0.0001) but increased in those in whom AF persisted (48.2+/-8.1mm vs 52.3+/-7.8mm; P=0.0001). CONCLUSION: The radial pattern of linear radiofrequency ablation used in the present study resulted in restoration of SR and atrial function. Procedural success was independent of preoperative atrial size. Restoration of SR results in 'reverse' atrial remodelling and improved atrial function. However atrial function remains modestly impaired, either due to the ablation lesions or pre-existing atrial disease.

Aged↗
PubMed1998

Effect of direct current shocks on left atrial mechanical function in patients with structural heart disease.

OBJECTIVES: This study examined the effect of endocardial and transthoracic direct current (DC) shocks on left atrial and left atrial appendage function in humans with structural heart disease. BACKGROUND: DC cardioversion of atrial fibrillation (AF) to sinus rhythm is associated with transient left atrial and left atrial appendage dysfunction and the development of spontaneous echo contrast (SEC). This phenomenon has been termed atrial "stunning" and may be associated with thrombus formation and embolic stroke. To what extent the shock itself contributes to atrial stunning is unclear. METHODS: Thirteen patients in sinus rhythm undergoing implantation of a ventricular implantable cardioverter defibrillator (ICD) were prospectively evaluated. All patients had significant structural heart disease. To evaluate the effects of DC shocks on left atrial and left atrial appendage function, biphasic R wave synchronized endocardial shocks of 1, 10 and 20 J were delivered between the right ventricular electrode and the left pectoral generator of the ICD in sinus rhythm. R wave synchronized transthoracic shocks of 360 J were also delivered between anteriorly and posteriorly positioned chest electrodes. Transesophageal echocardiography was performed to evaluate left atrial appendage velocities, mitral inflow velocities and the presence of SEC before and immediately after each DC shock. RESULTS: There were no significant changes in left atrial or left atrial appendage function after endocardial or transthoracic DC shocks. Left atrial SEC did not develop after endocardial or transthoracic DC shocks. CONCLUSIONS: Endocardial and transthoracic DC shocks are not directly responsible for left atrial and left atrial appendage stunning and do not contribute to the stunning that is observed after the cardioversion of AF to sinus rhythm.

Aged↗