This paper is only available as a PDF. To read, Please Download here.
Abstract
We investigated temporary changes in left atrial appendage (LAA) flow velocity patterns
in patients undergoing electrical cardioversion for chronic isolated atrial fibrillation,
and evaluated the role of active LAA contraction in directing blood flow to the left
atrial main chamber and left ventricle. The study consisted of 26 patients with chronic
isolated atrial fibrillation treated with electrical cardioversion and 20 normal controls
in sinus rhythm. Using transthoracic and transesophageal Doppler echocardiography,
we recorded transmitral, pulmonary venous, and LAA flow velocity patterns before,
24 hours, and 1 week after cardioversion in all subjects. In the 15 patients who underwent
successful cardioversion, the maximal LAA area 24 hours after cardioversion was smaller
than the area before cardioversion, whereas LAA ejection fraction during atrial systole
and peak atrial systolic emptying velocity of the LAA flow were lower 24 hours after
cardioversion than those in the control group. One week after cardioversion, maximal
LAA area and LAA peak atrial systolic emptying velocity were restored to levels approximately
equivalent to those in the control group, although LAA ejection fraction was lower
than in the control group. Maximal LAA area and LAA peak atrial systolic emptying
velocity correlated negatively and positively with LAA ejection fraction, respectively,
24 hours and 1 week after cardioversion. These results suggest that LAA and the left
atrial main chamber show stunning 24 hours after cardioversion, and the atrial systolic
emptying wave of LAA flow is generated by active LAA contraction.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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: 1359-1366
- Left atrial “stunning” after spontaneous conversion of atrial fibrillation demonstrated by transesophageal Doppler echocardiography.Am Heart J. 1995; 130: 174-176
- Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for “atrial stunning” as a mechanism, of thrombo-embolic complications.J Am Coll Cardiol. 1994; 23: 307-316
- Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation.J Am Coll Cardiol. 1994; 23: 1535-1540
- Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation.J Am Coll Cardiol. 1989; 13: 617-623
- Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm.Am J Cardiol. 1995; 75: 624-626
- Relation of left atrial appendage function to the duration and reversibility of nonvalvular atrial fibrillation.Am J Cardiol. 1995; 75: 944-947
- Changes in transmitral and pulmonary venous flow velocity patterns after cardioversion of atrial fibrillation.Am Heart J. 1996; 131: 270-275
- Evaluation of atrial active contraction and relaxation in various myocardial diseases by transesophageal pulsed Doppler echocardiography of left ventricular inflow and pulmonary venous flow.Am J Noninvas Cardiol. 1994; 8: 140-145
- Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus.Circulation. 1991; 84: 223-231
- Left atrial appendage blood flow determined by transesophageal echocardiography in healthy subjects.Am J Cardiol. 1993; 71: 976-981
- Pulsed Doppler characterization of left atrial appendage flow.J Am Soc Echocardiogr. 1993; 6: 237-244
- Influence of acutely altered loading conditions on left atrial appendage flow velocities.J Am Coll Cardiol. 1994; 24: 1117-1123
- Left atrial appendage dysfunction: a case of thrombosis? Evidence by transesophageal echocardiography-Doppler studies.J Am Soc Echocardiogr. 1991; 4: 435-441
- Left atrial appendage flow velocity assessment using transesophageal echocardiography in nonrheumatic atrial fibrillation and systemic embolism.Am J Cardiol. 1993; 71: 192-196
- Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo.J Am Coll Cardiol. 1994; 23: 961-969
- Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk.J Am Coll Cardiol. 1994; 23: 599-607
- Left atrial function and thrombus formation in atrial fibrillationflatter: A transesophageal echocardiographic study.J Am Coll Cardiol. 1994; 24: 159-164
- Ultrastructure of the myocardium of the atrial appendage.Br Heart J. 1966; 28: 796-807
Article info
Publication history
Accepted:
September 23,
1996
Received:
July 24,
1996
Identification
Copyright
© 1997 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc. All rights reserved.
