A Novel Echocardiographic Predictor of Atrial Fibrillation Recurrence: L‐Wave

Abstract

Diastolic dysfunction leads to atrial fibrillation (AF) by increasing left atrial pressure and also increases recurrence rate after cardioversion. So, L-wave, which is associated with severe diastolic dysfunction, could predict recurrent AF after cardioversion. The aim of this study was to investigate predictive value of L-wave for AF recurrence at first month after electrical cardioversion. A total of 127 patients with persistent AF were evaluated for this study and finally 73 patients were included according to the study criteria. Echocardiographic examinations were performed for all patients before and at 24th hour after electrical cardioversion. Heart rates and rhythms were followed with electrocardiography monitor and 12-lead ECG at first week and first month. Seventy patients achieved sinus rhythm (SR) after cardioversion and 3 patients who did not go into SR excluded from the study. Patients were divided into 2 groups according to having (group 1) or not having (group 2) L-wave on echocardiography. Twenty-two patients (6 men, 16 women) had L-wave and 48 patients (19 men, 29 women) did not have L-wave. Duration of AF was longer in group 1 as compared to group 2 (P = 0.03). Mean heart rate was lower in group 1 than in group 2 (P < 0.001). Duration of AF and presence of L-wave were significant parameters for AF recurrence in univariate analysis, however, presence of L-wave was the only significant parameter for AF recurrence in multivariate analysis. Ten patients in group 1 (45.5%) and 7 patients (14.6%) in group 2 (P = 0.005) had AF recurrence at the end of first month after cardioversion. L-wave did predict AF recurrence with 59% sensitivity, 77% specificity, 45% positive predictive value, and 85% negative predictive value at 1 month. Echocardiographic L-wave could predict the AF recurrence.

A Novel Index Combining Diastolic and Systolic Tissue Doppler Parameters for Prediction of Atrial Fibrillation Recurrence

“…AF recurrence is related with diastolic and systolic dysfunction of the left ventricle and LA. 9,10 Our results suggest that the together evaluation of systolic and diastolic mitral annular velocities could provide more comprehensive data about the cardiac function and AF recurrence.…”

“…Diastolic dysfunction and systolic dysfunction lead to AF by increasing of left ventricular and atrial pressure and also increase recurrence rate after cardioversion . E/Ea ratio is related to left ventricular diastolic function, and Sa velocity is related to left ventricular systolic function .…”

The predictive value of the combined systolic‐diastolic index for atrial fibrillation after coronary artery bypass surgery

“…As a result, diastolic dysfunction and systolic dysfunction facilitate AF formation by increasing left ventricular end‐diastolic pressure and thus left atrial pressures 32,33 . Thanks to the new indices obtained from conventional echocardiography and TDI measurements, it is possible to evaluate systole and diastole in combination.…”

The Value of Atrial Electromechanical Delay in Predicting Atrial Fibrillation Development After Coronary Artery Bypass Surgery

“…Atrial electromechanical delay (AEMD) defines the time interval between the initial point of P wave in 12-led electrocardiography (ECG) and the formation of the late diastolic wave in Tissue Doppler Imaging (TDI). This delay between the electrical stimulation and mechanical contraction, in other words, atrial electrophysiological changes, cause AF development by affecting the anatomy of atrium (6). Our aim in this study was to investigate the predictive value of AEMD duration, which can be easily detected by pre-operatively routinely performed ECG and transthoracic echocardiography (TTE) (using TDI), in the development of PoAF in isolated CABG patients.…”