Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation

Abstract

Objective: To determine prospectively whether interatrial dyssynchrony detected by tissue Doppler imaging

Relationships between P wave dispersion, atrial electromechanical delay, left atrial remodeling, and NT-proBNP levels, in patients with hypertrophic cardiomyopathy

“…P-wave dispersion [5] on surface ECG and atrial EMD [6] have been reported as risk factors for development of AF in various heart diseases. However, only a few studies have evaluated the relationship between PWD and atrial dyssynchrony.…”

“…Changes in atria may lead to electrical remodeling and affect the conduction properties of the atria, as is true in other cardiac pathologies [4]. Prolongation of atrial conduction can be assessed noninvasively by surface electrocardiography (ECG) measuring P wave duration (Pdur) [5] and and by tissue Doppler imaging (TDI) assessing atrial electromechanical dyssynchrony (EMD) [6]. These parameters and LA phasic functions have been used widely to predict development of atrial fibrillation (AF) episodes in patients with various heart diseases [5][6][7].…”

“…Prolongation of atrial conduction can be assessed noninvasively by surface electrocardiography (ECG) measuring P wave duration (Pdur) [5] and and by tissue Doppler imaging (TDI) assessing atrial electromechanical dyssynchrony (EMD) [6]. These parameters and LA phasic functions have been used widely to predict development of atrial fibrillation (AF) episodes in patients with various heart diseases [5][6][7]. Patients with HCM are more prone to development of AF, which is suggested to be a strong determinant of HCM-related morbidity and is the most common disease variable associated with progressive heart failure [8].…”

Left Atrial Function: Doppler and Strain

“…In patients undergoing cardioversion or ablation for AF, a′ has also been shown to deteriorate and then recover, similar to changes observed with mitral A velocity [57][58][59]. Decreased a′ has recently been shown to be a predictor for clinical deterioration in aortic stenosis [60], elevated pulmonary pressures in mitral regurgitation [44], AF post-coronary bypass grafting [61], and progression from paroxysmal to persistent nonvalvular AF [62]. In heart failure, low a′ is associated with poor exercise capacity [63] and is a better predictor of cardiac mortality than E/e′ and mitral deceleration time [64].…”

Left atrial dyssynchrony time measured by tissue Doppler imaging to predict atrial fibrillation recurrences after pulmonary vein isolation

“…Previous studies had proved that usage of atrial dyssynchrony is of clinical importance to predict the occurrence of AF; Sakabe et al (21) proved that interatrial dyssynchrony on TDI predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation. Cho et al (22) evaluated the usage of left atrial dyssynchrony assessed by strain imaging in predicting future development of atrial fibrillation in patients with heart failure, although this study had demonstrated that atrial dyssynchrony based on strain is the strongest univariate and multivariate predictor for new onset AF in hospitalized patients with congestive heart failure, however it concluded that atrial dyssynchrony based on tissue Doppler during the atrial contraction period failed to predict the development of new onset AF, we have some considerations regarding this point, the type of patients selected were congestive heart failure patients with no history of AF which differs from our study population, also one study by Van Beeumen et al (23) demonstrated that interatrial dyssynchrony, not intra-atrial dyssynchrony, was documented in patients with heart failure.…”