Atrial stunning: basics and clinical considerations

Khan, Ijaz A.

doi:10.1016/s0167-5273(03)00107-4

Cited by 120 publications

(121 citation statements)

References 114 publications

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“…2 This is thought to occur secondary to atrial stunning; with the resolution of stunning, SEC usually disappears. 19,20 Transesophageal Guided Cardioversion The conventional treatment for patients in atrial fibrillation >48 h who are to undergo cardioversion is pretreatment for 3 weeks with coumadin. This duration of anticoagulant therapy is associated with increased risk of bleeding, continued morbidity from AF, continued (though decreased) risk of embolism, additional cost for medicines and monitoring for level of anticoagulation, scheduling difficulties, delay of cardioversion, and increased refusal of patients to undergo cardioversion.…”

Section: Treatment Of Spontaneous Echo Contrastmentioning

confidence: 99%

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Patel

Flaker

2007

Clinical Cardiology

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The 2006 American Heart Association guidelines for management of patients with atrial fibrillation state: ''For patients with no identifiable thrombus in the left atrium (LA) or left atrial appendage (LAA), cardioversion (CV) is reasonable immediately after anticoagulation with unfractionated heparin. Thereafter, continuation of oral anticoagulation is reasonable for an anticoagulation period of at least 4 weeks.'' For patients with thrombus identified by transesophageal echocardiography, guidelines recommend therapeutic oral anticoagulation for 3 weeks prior to and 4 weeks after elective cardioversion.Patients with spontaneous echo contrast spontaneous echo contrast (SEC) identified by transesophageal echocardiogram (TEE) have a high risk of thromboembolic events, 1 -8 however, the guidelines do not address whether patients with SEC without thrombus can be safely cardioverted. This paper reviews the literature describing the pathogenesis of SEC, how it is detected, and whether elective cardioversion is safe.On the basis of our review, we believe that the risk of cardioembolic stroke after cardioversion of a patient with SEC is low, regardless of anticoagulation. The safe conclusion is that patients with SEC on TEE should receive therapeutic anticoagulation prior to cardioversion if possible and early cardioversion is not contraindicated.

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Section: Treatment Of Spontaneous Echo Contrastmentioning

confidence: 99%

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Patel

Flaker

2007

Clinical Cardiology

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“…[10][11][12][13][14] In addition to AF duration and the left atrial dimension, the left atrial appendage (LAA) mechanical function has been suggested as an important factor for successful CV of AF and the maintenance of SR. [15][16][17][18][19][20] After electrical CV, atrial mechanical stunning develops, which presents as diminished LAA flow velocities. 18,21 This atrial stunning can be reversed by isoproterenol infusion. 22,23 The LAA is a distinct structure from the left atrium proper, although it lies adjacent to the left atrium.…”

mentioning

confidence: 99%

Prognostic Implication of the Left Atrial Appendage Mechanical Reserve After Cardioversion of Atrial Fibrillation

Park

Shin

et al. 2008

Circ J

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trial fibrillation (AF) is the most common chronic arrhythmia seen in clinical practice and is associated with a high risk of systemic thromboembolism and heart failure. [1][2][3] Chronic AF causes atrial enlargement and impairs ventricular function through loss of coordinative atrial contraction. 2,4,5 Cardiac structural and functional changes caused by chronic AF can be reversed when the sinus rhythm is restored and maintained. [6][7][8][9] Electrical cardioversion (CV) is the most commonly used method among the several treatment modalities to restore sinus rhythm (SR). Although the immediate success rate of CV has been reported to be up to 70-95%, the rate of long term SR maintenance is only approximately 50-60%. [10][11][12][13][14] In addition to AF duration and the left atrial dimension, the left atrial appendage (LAA) mechanical function has been suggested as an important factor for successful CV of AF and the maintenance of SR. [15][16][17][18][19][20] After electrical CV, atrial mechanical stunning develops, which presents as diminished LAA flow velocities. 18,21 This atrial stunning can be reversed by isoproterenol infusion. 22,23 The LAA is a distinct structure from the left atrium proper, although it lies adjacent to the left atrium. Its function has not been fully elucidated and a valid evaluation method has not been determined in cardioverted AF. In this study, we investigated a valid method for the evaluation of LAA mechanical reserve in cardioverted AF and demonstrated that increases in the LAA emptying velocity (LAAEV) and in the LAA filling velocity (LAAFV) with isoproterenol infusion after CV of AF can predict the long-term maintenance of SR. Methods Study PopulationSixty-seven consecutive chronic AF patients who had been successfully cardioverted to SR by direct current electrical CV between 2004 and 2005 were included in this study. Of them, 14 were excluded because of unsuitable echocardiographic image quality or follow-up loss, and a total of 53 patients were finally assessed. The mean age of the patients was 59±3 years (range, 40-76 years) and 40 were male (M/F =40/13). The mean duration of AF was 24±4 months (range, 1-72 months). Associated diseases were hypertension in 26 patients, diabetes mellitus in 3 patients, ischemic heart disease in 1 patient, and cerebrovascular disease in 4 patients. All patients gave written informed consent to participate in the study and the study protocol was approved by the institutional ethic committee for clinical trials. This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF). Methods and Results 53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59±3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 ...

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“…Although the ablation is done epicardially, the transmurality of the lesion might lead to damage on the endocardial surface and a greater risk of thrombus development in the LA. Furthermore, since the majority of patients suffer from persistent or long-standing persistent AF (e.g., in the de Asmundis report, 92% of patients were in AF at the beginning of the surgery) (1), and thus most of them are cardioverted to sinus rhythm during ablation (either by the ablation itself or by direct current cardioversion), the resulting left atrial stunning (which is recognized as pro-thrombus) could contribute to thrombus formation (12). Lastly, in most studies, no anticoagulation was given during the thoracoscopic ablation (or at least no heparin was reported given).…”

Section: Safety Of Hybrid Ablationmentioning

confidence: 99%

The future of hybrid ablation: an emerging need for an anticoagulation protocol for thoracoscopic ablation

Osmančík

Budera

2017

J. Thorac. Dis.

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Atrial stunning: basics and clinical considerations

Cited by 120 publications

References 114 publications

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Prognostic Implication of the Left Atrial Appendage Mechanical Reserve After Cardioversion of Atrial Fibrillation

The future of hybrid ablation: an emerging need for an anticoagulation protocol for thoracoscopic ablation

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