Effect of an irregular ventricular rhythm on cardiac output

Daoud, Emile G.; Weiss, Raul; Bahu, Marwan; Knight, Bradley P.; Bogun, Frank; Goyal, Rajiva; Harvey, Mark; Strickberger, S. Adam; Man, K. Ching; Morady, Fred

doi:10.1016/s0002-9149(97)89297-1

Cited by 309 publications

(157 citation statements)

References 11 publications

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“…[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.…”

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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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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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“…It is well established that, for patients with highly symptomatic medically refractory permanent AF, AVJAP provides superior symptom relief compared with pharmacologic management (2-6,10). Early nonrandomized studies suggested that AVJAP also improves cardiac function (2-4), and the reasons suggested for this improvement were reversal of tachycardia-related cardiomyopathy (11,12) as well as the favorable hemodynamic effects of a regular ventricular rhythm (13). Two prospective randomized trials (5,6) reported results while the present study was underway.…”

Section: Discussionmentioning

confidence: 74%

The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

Weerasooriya¹,

Davis²,

Powell³

2003

ACC Current Journal Review

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OBJECTIVESThe Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial was a multicenter trial of atrioventricular junction ablation and pacing (AVJAP) compared with pharmacologic ventricular rate control (medication [MED]) in patients with mild to moderately symptomatic permanent atrial fibrillation (AF). BACKGROUND There have been very few prospective randomized trials, undertaken in highly symptomatic patients, comparing AVJAP with pharmacologic methods of ventricular rate control for patients with permanent AF. METHODSThere were 99 patients (70 men, mean age 68 Ϯ 8.6 years) at five centers. Forty-nine patients were randomized to AVJAP while 50 patients were randomized to pharmacologic control. The primary end point was cardiac function measured by echocardiography and exercise tolerance. The secondary end points were ventricular rate control, evaluated by 24-h ambulatory electrocardiographic monitoring, and quality of life. Data were collected at randomization and then at one month, six months, and 12 months post-randomization. RESULTSAt 12 months follow-up there was no significant difference in left ventricular ejection fraction (AVJAP: 54 Ϯ 17%; MED: 61 Ϯ 13% [p ϭ ns]) or exercise duration on treadmill testing (AVJAP: 4.1 Ϯ 2 min; MED: 4.6 Ϯ 2 min [p ϭ ns]); however, the peak ventricular rate was lower in the AVJAP group during exercise (112 Ϯ 17 beats/min vs. 153 Ϯ 36 beats/min, p Ͻ 0.05) and activities of daily life (117 Ϯ 16 beats/min vs. 152 Ϯ 37 beats/min, p Ͻ 0.05).The CAST quality-of-life questionnaire revealed that patients in the AVJAP group had fewer symptoms at six months (p ϭ 0.003) and at 12 months (p ϭ 0.004). The observed relative risk reduction in symptoms at 12 months was 18%. Global subjective semiquantitative measurement of quality of life using the "ladder of life" revealed that the AVJAP group reported a 6% better quality of life at six months (p ϭ 0.011). Atrial fibrillation (AF) is the most common chronic tachyarrhythmia, affecting 5% of people over the age of 60 (1). Ventricular rate control is a major treatment aim for patients with permanent AF. Although several studies have com- See page 1703pared atrioventricular junction ablation and pacing (AVJAP) with pharmacologic ventricular rate control in AF, earlier studies were not randomized (2-4), and the few published randomized prospective studies comparing the two treatment options have included very symptomatic patients with a mean left ventricular ejection fraction (LVEF) Ͻ50 (5,6). The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT) was a multicenter, prospective randomized trial of AVJAP versus pharmacologic treatment for ventricular rate control and was undertaken in patients with permanent AF who had mild to moderate symptoms, preserved LVEF, and a ventricular rate that was controlled pharmacologically. AVJAP has not been compared to pharmacologic therapy in this population, which represents the great majority of patients with permanent AF.The primary end point...

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“…Because of aortic and mitral valvular insufficiency leading to impaired ventricular function and decreased diastolic filling mild hypotension was noticed in our patient. In men atrial fibrillation leads to reduced cardiac output (Daoud et al 1996). Cardiovascular function during anaesthesia is well maintained in horses with atrial fibrillation without underlying cardiac disease (Schauvliege et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Sedation management for standing enucleation of the left eye in a 37 years old horse with decompensated left heart failure

Hopster¹,

Kästner²

2013

PHK

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SummaryA 37 year old Arabian horse was presented for enucleation. Because of decompensated left heart failure and pulmonary oedema the decision for surgery in a standing position was made. The horse was sedated with acepromazine, levomethadone and xylazine and the supraorbital, lacrimal, infratrochlear and zygomatic nerve were blocked for desensitizing of the eyelids. In addition, an auriculopalpebral and a retrobulbar block were performed to obtain palpebral akinesia and to prevent the occurrence of the oculocardiac reflex. The eye was enucleated without any adverse effects with the horse standing calm and stable without any signs of pain.

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Effect of an irregular ventricular rhythm on cardiac output

Cited by 309 publications

References 11 publications

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

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

The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

Sedation management for standing enucleation of the left eye in a 37 years old horse with decompensated left heart failure

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