Hemodynamic Changes After Cardioversion of Chronic Atrial Fibrillation

Upshaw, Charles B.

doi:10.1001/archinte.1997.00440310032003

Cited by 93 publications

(52 citation statements)

References 55 publications

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“…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%.…”

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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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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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“…Such conduction disturbances may further exacerbate mitral regurgitation and limit ventricular filling. Controlling the ventricular rate and regularity may reverse these adverse hemodynamic effects, however, the changes can persist for a prolonged time even after cardioversion (Upshaw, 1997). Tachycardia-induced cardiomyopathy tends to resolve within 6 months of rate or rhythm control; when tachycardia recurs, LV ejection fraction declines and HF develops over a shorter period, this is associated with a relatively poor prognosis (Nerheim et al, 2004).…”

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confidence: 99%

Atrioventricular Conduction in Atrial Fibrillation: Pathophysiology and Clinical Implications

Róka¹

2012

Atrial Fibrillation - Basic Research and Clinical Applications

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“…It typically occurs between the first and the fifth day following surgery with frequency peak on the second day [2]. Although it is well tolerated in the majority of the patients [3], AF can result in hemodynamic instability, especially in those patients with left ventricular diastolic dysfunction because they present a reduced tolerance to the loss of atrial contraction [4]. Limiting the use of betablockers and amiodarone [5,6], as a prophylactic pharmacological measurement of postoperative AF, have induced studies regarding prophylactic nonpharmacological measurements.…”

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confidence: 99%

Efeitos da estimulação temporária atrial direita na prevenção da fibrilação atrial no pós-operatório de revascularização do miocárdio com circulação extracorpórea

Neto¹,

Costa

Silva³

et al. 2007

Rev Bras Cir Cardiovasc

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Efeitos da estimulação temporária atrial direita na prevenção da fibrilação atrial no pós-operatório de revascularização do miocárdio com circulação extracorpórea Effect of temporary right atrial pacing in prevention of atrial fibrillation after coronary artery bypass graft surgery Abstract Objective: To evaluated the effects of temporary atrial pacing to prevent the atrial fibrillation following coronary artery bypass graft surgery and the risk factors to the occurrence of this arrhytmia.Methods: We have studied 160 patients who, at the end of coronary artery bypass graft surgery, were submitted to epicardial electrode implantation in the right atrium lateral wall. They were randomized into two groups: non-pacing (NP) group and right atrial (RA) pacing group. The cardiac rhythm was monitorized over 72 hours following to the end of surgery and the variables studied were as follow: incidence of atrial fibrillation; the risk factors pre-, intra-, and postoperative for its occurrence, and postoperative events.Results: There were 21 (13.1%) episodes of atrial fibrillation, 20 in the NP group and one in the RA group. The relative risk (RR) for the development of atrial fibrillation was 0.18 (95% CI; 0.05-0.60) for the RA group 333 AVILA NETO, V ET AL -Effect of temporary right atrial pacing in prevention of atrial fibrillation after coronary artery bypass graft surgery Bras Cir Cardiovasc 2007; 22(3): 332-340 Rev

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Hemodynamic Changes After Cardioversion of Chronic Atrial Fibrillation

Cited by 93 publications

References 55 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

Atrioventricular Conduction in Atrial Fibrillation: Pathophysiology and Clinical Implications

Efeitos da estimulação temporária atrial direita na prevenção da fibrilação atrial no pós-operatório de revascularização do miocárdio com circulação extracorpórea

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