V-a Pco(2) was a significant predictor of fatal outcome only in the non-ventilated group of patients. Ventilated patients are more likely to be admitted with a less favorable clinical status, and other variables seem to have a more important role in their outcome.

Objective-To evaluate the time course of the recovery of atrial mechanical function after pharmacological cardioversion of chronic atrial fibrillation to sinus rhythm. Patients and methods-21 patients (12 male, 9 female, aged 37-77 years) with chronic atrial fibrillation (< 6 months) were followed up by serial transmitral pulsed Doppler echocardiography. Echocardiographic studies were performed within the first 24 hours and on day 8, 15, and 30 after cardioversion. Results-There was a significant increase (mean (SD)) in the peak A-wave velocity (from 0 35 (0.10) on day 1 to 0 50 (1.73) on day 8, and thereafter a gradual increase to 0*61 (0.14) m/s on day 30). Similarly, integrated late atrial velocities increased from 4 50 (1.46) on day 1 to 5*61 (1.73) on day 8 and 5*97 (1.47) cm/s2 on day 30. The atrial contribution to total transmitral flow increased significantly from 26 (7)% immediately after conversion of atrial fibrillation to sinus rhythm to 34 (7)% on day 30, indicating the haemodynamic benefit of the restoration of sinus rhythm. Left atrial diameter decreased but not significantly, from 4-11 (0.37) to 3-98 (0.34) cm (P < 0.005). In more than 75% of elderly AF patients, the aetiology includes arterial hypertension and sick sinus syndrome, whereas mitral valve disease, thyrotoxicosis, alcohol, anaemia, pericarditis, and cardiosurgical procedures are important aetiological factors in younger patients.4 Elimination of these factors is a precondition for achieving sinus rhythm, and vital for maintaining it. However, in 3% to 31% of cases, AF occurs as an isolated event ("lone atrial fibrillation") without a recognisable cause or structural heart disease.5-7In each patient with AF the aim of treatment is to restore sinus rhythm.

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