Background and objectives: The role of atrial myocardial dysfunction after cardioversion is unclear. In a comparison of patients after successful cardioversion from chronic atrial fibrillation (CAF) and normal controls, we sought to determine whether Doppler-derived atrial strain rate (A-sr) could be used to measure global left atrial function and whether A-sr was reduced in patients with CAF. Methods: A-sr was measured from the basal septal, lateral, inferior and anterior atrial walls from the apical four-chamber and two-chamber views in 37 patients with CAF who had been cardioverted to sinus rhythm and followed up for 6 months, and in a cohort of 37 healthy people. Conventional measures of atrial function included peak transmitral A-wave velocity, A-wave velocity time integral, atrial fraction and the left atrial ejection fraction. Doppler tissue imaging was used to estimate atrial contraction velocity (A9 velocity). In addition to amplitude parameters, the time to peak A-sr was measured from aortic valve closure. Results: Immediately after cardioversion, A-sr in the CAF cohort (baseline) was significantly lower than in controls (mean (SD) 20.53 (0.31) v 21.6 (0.75) s 21 ; p,0.001); the A-sr correlated with A9 velocity (r = 0.63; p,0.001) in patients. Atrial function improved over time, with maximal change observed in the initial 4 weeks after cardioversion. The time to peak A-sr was increased in the CAF group compared with controls (0.55 (0.15) v 0.46 (0.12) s), but this failed to normalise over time. Conclusion: A-sr is a descriptor of atrial function, which is reduced after cardioversion from CAF and subsequently recovers.

In the present study, increased LV mass was the strongest predictor of LAA thrombus in persistent AF. LA SEC and RA SEC were univariate predictors of LAA thrombus but did not add predictive value to a multivariate model including LV mass. This study highlights the importance of diagnosing and treating LV hypertrophy associated with persistent AF, which may reduce the risk of LAA thrombus and thrombo-embolic stroke.

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The crista terminalis and Eustachian ridge are normal anatomical structures within the right atrium that are not normally looked for or visualised in the standard views obtained while performing a transthoracic echocardiogram (TTE). In this case report, the prominent terminal ridge (a normal anatomical variant) appeared as a "mass" in the right atrium that needed to be differentiated from a pathological cardiac mass. Identification of physiological structures in the right atrium on TTE using additional 3D imaging can avoid unnecessary additional tests that are both more invasive and expensive such as transesophageal echocardiography or MRIs.