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Eur J Heart Fail 2002; 4:263. 33. Silvet H, Young-Xu Y, Walleigh D, Ravid S. Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol 2003; 92:1124. 34. Kihara T, Gillinov AM, Takasaki K, et al. Mitral regurgitation associated with mitral annular dilation in patients with lone atrial fibrillation: an echocardiographic study. Echocardiography 2009; 26:885. 35. Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol 2011; 58:1474. 36. Tanimoto M, Pai RG. Effect of isolated left atrial enlargement on mitral annular size and valve competence. Am J Cardiol 1996; 77:769. 37. Otsuji Y, Kumanohoso T, Yoshifuku S, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. 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Reversal of atrial mechanical stunning after cardioversion of atrial arrhythmias: implications for the mechanisms of tachycardia- mediated atrial cardiomyopathy. Circulation 2002; 106:1806. 43. Louie EK, Liu D, Reynertson SI, et al. "Stunning" of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm: demonstration by transesophageal Doppler techniques in a canine model. J Am Coll Cardiol 1998; 32:2081. 44. Grimm RA, Stewart WJ, Maloney JD, et al. Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: characterization by simultaneous transesophageal echocardiography. J Am Coll Cardiol 1993; 22:1359. 45. Mattioli AV, Castelli A, Andria A, Mattioli G. Clinical and echocardiographic features influencing recovery of atrial function after cardioversion of atrial fibrillation. Am J Cardiol 1998; 82:1368. 46. Harjai K, Mobarek S, Abi-Samra F, et al. 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Topic 1041 Version 23.0 https://www.uptodate.com/contents/hemodynamic-consequences-of-atrial-fibrillation-and-cardioversion-to-sinus-rhythm/print 15/18 7/5/23, 9:14 AM Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm - UpToDate GRAPHICS NYHA and other classifications of cardiovascular disability Canadian NYHA functional [1] Cardiovascular Specific activity Class [3] classification Society functional scale [2] classification I Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous or rapid Patients can perform to completion any activity requiring 7 metabolic equivalents (ie, can carry 24 lb up 8 steps; do outdoor work undue fatigue, palpitation, dyspnea, or anginal pain. prolonged exertion at work or recreation. [shovel snow, spade soil]; do recreational activities [skiing, basketball, squash, handball, jog/walk 5 mph]). II Patients with cardiac disease resulting in Slight limitation of ordinary activity. Patients can perform to completion any activity requiring 5 metabolic equivalents (eg, have sexual intercourse without stopping, garden, rake, weed, roller skate, dance slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, Walking or climbing stairs rapidly, walking uphill, walking or stair- climbing after meals, in cold, in wind, or when under emotional dyspnea, or anginal pain. stress, or only during the few hours after awakening. Walking more than 2 blocks on the level and climbing more than 1 flight of foxtrot, walk at 4 mph on level ground) but cannot and do not perform to completion activities requiring 7 metabolic equivalents. ordinary stairs at a normal pace and in normal conditions. III Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Marked limitation of ordinary physical activity. Walking 1 to 2 blocks on the level and climbing 1 flight in Patients can perform to completion any activity requiring 2 metabolic equivalents (eg, shower without stopping, strip Less-than-ordinary normal conditions. and make bed, clean https://www.uptodate.com/contents/hemodynamic-consequences-of-atrial-fibrillation-and-cardioversion-to-sinus-rhythm/print 16/18 7/5/23, 9:14 AM Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm - UpToDate physical activity causes fatigue, palpitation, dyspnea, or anginal pain. windows, walk 2.5 mph, bowl, play golf, dress without stopping) but cannot and do not perform to completion any activities requiring >5 metabolic equivalents. IV Patients with cardiac disease resulting in inability to carry on any physical activity Inability to carry on any physical activity without discomfort. Anginal syndrome may Patients cannot or do not perform to completion activities requiring >2 metabolic without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity be present at rest. equivalents. Cannot carry out activities listed above (specific activity scale III). is undertaken, discomfort is increased. NYHA: New York Heart Association. References: 1. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the th Heart and Great Vessels, 9 ed, Little, Brown & Co, Boston 1994. p.253. 2. Campeau L. Grading of angina pectoris. Circulation 1976 54:522. 3. Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: Advantages of a new speci c activity scale. Circulation 1981; 64:1227. Graphic 52683 Version 19.0 https://www.uptodate.com/contents/hemodynamic-consequences-of-atrial-fibrillation-and-cardioversion-to-sinus-rhythm/print 17/18 7/5/23, 9:14 AM Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm - UpToDate Contributor Disclosures Gregory YH Lip, MD, FRCPE, FESC, FACC Consultant/Advisory Boards: BMS/Pfizer [Atrial fibrillation and thrombosis]; Boehringer Ingelheim [Atrial fibrillation and thrombosis]; Daiichi-Sankyo [Atrial fibrillation and thrombosis]. Speaker's Bureau: BMS/Pfizer [Atrial fibrillation and thrombosis]; Boehringer Ingelheim [Atrial fibrillation and thrombosis]; Daiichi-Sankyo [Atrial fibrillation and thrombosis]. All of the relevant financial relationships listed have been mitigated. Jordan M Prutkin, MD, MHS, FHRS No relevant financial relationship(s) with ineligible companies to disclose. Bradley P Knight, MD, FACC Grant/Research/Clinical Trial Support: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; MDT [Electrophysiology]; Philips [Electrophysiology]. Consultant/Advisory Boards: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; CVRx [Heart failure]; MDT [Electrophysiology]; Philips [Electrophysiology]; Sanofi [Arrhythmias]. Speaker's Bureau: Abbott [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Transeptal catheterization]; BSCI [Electrophysiology]; MDT [Electrophysiology]. All of the relevant financial relationships listed have been mitigated. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/hemodynamic-consequences-of-atrial-fibrillation-and-cardioversion-to-sinus-rhythm/print 18/18