Perspective:

Persistence of AF is known to promote anatomic, autonomic, and electrophysiological changes in the LA, which in turn contribute to the perpetuation of AF. Prior studies have focused on the LA size and function in this condition, while the current study extended observations to remodeling of other heart chambers and atrial functional mitral and tricuspid regurgitation. Using 3-D echocardiography, the authors of the present study show that successful restoration of SR with cardioversion, antiarrhythmic medication, and/or ablation results in reverse remodeling with decreases in all atrial Vi, ES RV Vi, an increase in ED left ventricular Vi, and an improvement in four-chambers function. In contradistinction, patients in whom SR restoration was either not attempted or unsuccessful experienced an increase in ED LA Vi and ED/ES RV Vi without modification of four-chambers function, except for a decrease in LA emptying fraction. Additionally, there was a reduction in the severity of mitral and tricuspid regurgitation after active restoration of SR, which was not observed in patients who remained in AF. This prospective observational study suggests that restoration of SR should be attempted to improve cavity reverse remodeling and severity of functional regurgitation. A randomized study will be necessary to confirm these findings.