Non-invasive detection of left atrial mechanical failure in patients with left ventricular disease.

Abstract

Left atrial mechanical failure may be present in patients with left ventricular disease despite normal sinus rhythm. Normal atrial activation on 12 lead electrocardiogram suggests it is primarily mechanical in origin. The possibility of left atrial mechanical failure must be considered when Doppler patterns of transmitral flow are used to assess left ventricular diastolic function.

Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

“…This finding indirectly confirms the dynamics of LASF and its dependence on LV preload, and is in line with previous publications 7,23,24 . Whereas mitral valve area is mainly associated with LA volume, reflecting mean LV filling pressure over time, 25 mitral peak A velocity is mostly associated with actual LV filling pressure 25–27 …”

“…An intrinsic systolic LA dysfunction has been described in various types of cardiomyopathies and was associated with LA thrombus formation 36,37 . A severe LA infiltration of fibrosis or amyloid has been supposed as etiologic mechanism of intrinsic mechanical LA systolic function in patients with dilated or restrictive cardiomyopathy, respectively, however it may also be caused by subclinical coronary artery disease, as suggested from previous reports 26,36,37 . In our patients, the last condition might be a possible etiology.…”

Left atrial systolic function is depressed in idiopathic and preserved in ischemic dilated cardiomyopathy

“…It is reasonable therefore to assume that the intrinsic left atrial mechanical dysfunction observed in idiopathic dilated cardiomyopathy is most likely a result of atrial involvement in the myopathic process. This is supported by the findings of recent studies which demonstrated that: 1) the left atrial systolic function is depressed in idiopathic dilated cardiomyopathy compared to aortic stenosis [13] or hypertrophic cardiomyo-pathy [14]; 2) fifty per cent of the patients with atrial paralysis in the setting of left ventricular dysfunction suffer from idiopathic dilated cardiomyopathy [23]; and 3) there are histologic changes in the left atrium in idiopathic dilated cardiomyo-pathy unrelated to left atrial mechanical overload [15][16][17].…”

Ebstein's anomaly, atrial paralysis and atrio-ventricular block: an uncommon association

“…Preexcitation syndromes occur in up to 10% of patients. Symptomatic arrhythmias are present among 30% of Ebsteins' cases, including atrial flutter or fibrillation [8][9][10] , the latter occasionally related to pulmonary hypertension and atrial septal defect. In a series of 401 patients, only 15 (3·7%) required some form of permanent pacing [6] .…”