Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: Characterization by simultaneous transesophageal echocardiography

Grimm, Richard A.; Stewart, William J.; Maloney, James D.; Cohen, Gerald I.; Pearce, Gregory L.; Salcedo, Eranesto E.; Klein, Allan L.

doi:10.1016/0735-1097(93)90543-a

Cited by 294 publications

(107 citation statements)

References 28 publications

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“…[1][2][3][4][5][6] The present study confirms the development of significant stunning on termination of chronic AFL by RFA or pacing, adding to the evidence implicating the preceding arrhythmia rather than the mode of cardioversion in the development of atrial stunning.…”

Section: Implications For the Mechanism Of Atrial Mechanical Remodelisupporting

confidence: 71%

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Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

et al. 2002

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Background-Atrial mechanical stunning develops on termination of chronic atrial arrhythmias and is implicated in the genesis of thromboembolic complications after cardioversion. The mechanisms responsible for atrial mechanical stunning are unknown. The effects of atrial rate, isoproterenol, and calcium on atrial mechanical function in patients with atrial stunning have not been evaluated, and it is not known if atrial stunning can be reversed. Methods and Results-Thirty-five patients with chronic atrial flutter (AFL) undergoing radiofrequency ablation were studied. Fifteen patients in sinus rhythm undergoing ablation for paroxysmal AFL were studied as control for effects of the procedure. Left atrial appendage emptying velocities (LAAEVs) and spontaneous echocardiographic contrast (LASEC) were assessed by transesophageal echocardiography during AFL, after reversion to sinus rhythm, during atrial pacing at cycle lengths of 750 to 250 ms, after a postpacing pause, and with isoproterenol or calcium. PϽ0.0001). No change in LAAEV was observed in the paroxysmal AFL group. Conclusion-Atrial mechanical stunning can be reversed by pacing at increased rates and through the administration of isoproterenol or calcium. These findings suggest a functional contractile apparatus in the mechanically remodeled atrium as a result of chronic atrial flutter.

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Section: Implications For the Mechanism Of Atrial Mechanical Remodelisupporting

confidence: 71%

“…[1][2][3][4][5][6] After cardioversion, transesophageal echocardiographic (TEE) studies have demonstrated the development of left atrial spontaneous echocardiographic contrast (LASEC) and thrombus. This process has been termed atrial mechanical stunning and is implicated in the development of thromboembolic stroke after cardioversion.…”

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confidence: 99%

Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

et al. 2002

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“…Conventionally, atrial stunning refers to a reduction in atrial appendage contractile function after conversion of AF compared with the contractile function during AF before cardioversion. [1][2][3][4][5][6] If this definition of stunning had been used in the present study, no contractile dysfunction would have been recognized, because the mean emptying velocity during AF (52Ϯ21 cm/s) was less than the emptying velocity after conversion. Therefore, future studies assessing atrial contractile dysfunction and its recovery should compare contractile function immediately after AF conversion to contractile function measured in sinus rhythm at a later time, after maximum recovery.…”

Section: Previous Clinical Studiesmentioning

confidence: 99%

“…[1][2][3][4][5][6] The major limitations of these studies were that there was no assessment of LAA function before the onset of AF and that the duration of AF was poorly defined. The present study is unique in that the duration of AF was timed and the LAA emptying velocity could be measured immediately before, during, and for several minutes after AF conversion.…”

Section: Previous Clinical Studiesmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] A study of pacing-induced AF in pigs demonstrated that a brief episode of AF induces acute atrial contractile dysfunction and that this can be blunted by verapamil. 9 However, no prior studies have assessed the short-term effect of a brief episode of AF on left atrial contractility in humans or the effect of pretreatment with verapamil.…”

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confidence: 99%

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Short-Term Effect of Atrial Fibrillation on Atrial Contractile Function in Humans

et al. 1999

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Background-Conversion of chronic atrial fibrillation (AF) is associated with atrial stunning, but the short-term effect of a brief episode of AF on left atrial appendage (LAA) emptying velocity is unknown. The purpose of this study was to determine whether a short episode of AF affects left atrial function and whether verapamil modifies this effect. Methods and Results-The subjects of this study were 19 patients without structural heart disease undergoing an electrophysiology procedure. In 13 patients, LAA emptying velocity was measured by transesophageal echocardiography in the setting of pharmacological autonomic blockade before, during, and after a short episode of AF. During sinus rhythm, the baseline LAA emptying velocity was measured 5 times and averaged. AF was then induced by rapid right atrial pacing. After either spontaneous or electrical conversion, LAA emptying velocity was measured immediately on resumption of sinus rhythm and every minute thereafter. The mean duration of AF was 15.3Ϯ3.8 minutes. The mean baseline emptying velocity was 70Ϯ20 cm/s. The first post-AF emptying velocity was 63Ϯ20 cm/s (Pϭ0.02 versus baseline emptying velocity). The post-AF emptying velocity returned to the baseline emptying velocity value after 3.0 minutes. The mean percent reduction in post-AF emptying velocity was 9.7Ϯ21% (range, 15% increase to 56% decrease). A second group of 6 patients were pretreated with verapamil (0.1-mg/kg IV bolus followed by an infusion of 0.005 mg ⅐ kg Ϫ1 ⅐ min

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Atrial Plasticity

Sanders¹,

Morton²,

and³

et al. 2005

Innovative Management of Atrial Fibrillation

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Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: Characterization by simultaneous transesophageal echocardiography

Cited by 294 publications

References 28 publications

Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

Short-Term Effect of Atrial Fibrillation on Atrial Contractile Function in Humans

Atrial Plasticity

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