Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation

Manning, Warren J.; Leeman, David; Gotch, Patricia J.; Come, Patricia C.

doi:10.1016/0735-1097(89)90602-5

Cited by 343 publications

(133 citation statements)

References 21 publications

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“…Multiple studies have used this parameter as an index of LA function assessment, but it is affected by age and loading conditions. 317,[374][375][376][377][378][379][380][381][382] The PV atrial reversal velocity has also been used as a measurement of LA function. 317,377,[379][380][381][382] In the presence of reduced LV compliance and elevated filling pressures, atrial contraction results in significant flow reversal into the PVs.…”

Section: Left Atrial Function By Doppler Echocardiographymentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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Section: Left Atrial Function By Doppler Echocardiographymentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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“…It has been proposed that mild impairment of ventricular pump function due to the high ventricular rate during AF might increase end-diastolic ventricular and atrial pressures (12). An alternative explanation might be that the pronounced atrial contractile dysfunction of the atria induced by AF (6,7,10) underlies the dilatation of fibrillating atria. In theory, loss of contractility in fibrillating atria is expected to increase atrial compliance and size.…”

mentioning

confidence: 99%

Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation

Schotten¹,

Haan²,

Neuberger³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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Allessie. Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation. Am J Physiol Heart Circ Physiol 287: H2324 -H2331, 2004. First published July 15, 2004 doi: 10.1152/ajpheart.00581.2004.-Atrial fibrillation (AF) induces a progressive dilatation of the atria which in turn might promote the arrhythmia. The mechanism of atrial dilatation during AF is not known. To test the hypothesis that loss of atrial contractile function is a primary cause of atrial dilatation during the first days of AF, eight goats were chronically instrumented with epicardial electrodes, a pressure transducer in the right atrium, and piezoelectric crystals to measure right atrial diameter. AF was induced with the use of repetitive burst pacing. Atrial contractility was assessed during sinus rhythm, atrial pacing (160-, 300-, and 400-ms cycle length), and electrically induced AF. The compliance of the fibrillating right atrium was measured during unloading the atria with diuretics and loading with 1 liter of saline. All measurements were repeated after 6, 12, and 24 h of AF and then once a day during the first 5 days of AF. Recovery of the observed changes after spontaneous cardioversion was also studied. After 5 days of AF, atrial contractility during sinus rhythm or slow atrial pacing was greatly reduced. During rapid pacing (160 ms) or AF, the amplitude of the atrial pressure waves had declined to 20% of control. The compliance of the fibrillating atria increased twofold, whereas the right atrial pressure was unchanged. As a result, the mean right atrial diameter increased by ϳ12%. All changes were reversible within 3 days of sinus rhythm. We conclude that atrial dilatation during the first days of AF is due to an increase in atrial compliance caused by loss of atrial contractility during AF. Atrial compliance and size are restored when atrial contractility recovers after cardioversion of AF. stunning; remodeling; atrial tachyarrhythmias A RELATIONSHIP between atrial size and atrial fibrillation (AF) was first proposed by Fraser and Turner in 1955 (1), who showed that AF was more common in patients with enlarged atria than in patients with normal atrial size. In the 1990s, large prospective trials established left atrial enlargement as an independent risk factor for the development of AF (13,14). Today, it is generally accepted that AF is not only a consequence but also a cause of atrial dilatation. In patients with "lone AF," Sanfilippo et al. (9) demonstrated that AF resulted in progressive atrial dilatation, which in turn, might contribute to the self-perpetuating nature of the arrhythmia.The mechanism of atrial dilatation related to AF is still unclear. It has been proposed that mild impairment of ventricular pump function due to the high ventricular rate during AF might increase end-diastolic ventricular and atrial pressures (12). An alternative explanation might be that the pronounced atrial contractile dysfunction of the atria induced by AF (6, 7, 10) underlies the dilatation of ...

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“…In patients with AF, impairment in left ventricular (LV) systolic functions leads to increased LV and left atrium (LA) filling pressures along with function loss in left atrial appendage (LAA), blood stasis and hence to spontaneous echo contrast (SEC) and formation of thrombus (2,3). Likewise, in patients with disturbed diastolic function, increasing LV end-diastolic pressure and LA pressure give rise to decrease in filling and emptying velocities of LAA (2,3).Thus, as blood stasis and formation of SEC will be enhanced in LAA, the formation of thrombus will be facilitated. So evaluation of the left atrial appendage functions in patients with diastolic dysfunction are important by transesophageal echocardiography (TEE).…”

Section: Introductionmentioning

confidence: 99%

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

Demirçelik¹,

Çetın²,

Çiçekçioğlu³

et al. 2014

Anadolu Kardiyol Derg

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Objective: We aimed to investigate effects of left ventricular diastolic dysfunction on left atrial appendage functions, spontaneous echo contrast and thrombus formation in patients with nonvalvular atrial fibrillation. Methods: In 58 patients with chronic nonvalvular atrial fibrilation and preserved left ventricular systolic function, left atrial appendage functions, left atrial spontaneous echo contrast grading and left ventricular diastolic functions were evaluated using transthoracic and transoesophageal echocardiogram. Patients divided in two groups: Group D (n=30): Patients with diastolic dysfunction, Group N (n=28): Patients without diastolic dysfunction. Categorical variables in two groups were evaluated with Pearson's chi-square or Fisher's exact test. The significance of the lineer correlation between the degree of spontaneous echo contrast (SEC) and clinical measurements was evaluated with Spearman's correlation analysis. Results: Peak pulmonary vein D velocity of the Group D was significantly higher than the Group N (p=0.006). However, left atrial appendage emptying velocity, left atrial appendage lateral wall velocity, peak pulmonary vein S, pulmonary vein S/D ratio were found to be significantly lower in Group D (p=0.028, p<0.001, p<0.001; p<0.001). Statistically significant negative correlation was found between SEC in left atrium and left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities respectively (r=-0.438, r=-0.328, r=-0.233, r=-0.447). Left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities were significantly lower in SEC 2-3-4 than SEC 1 (p=0.003, p=0.029, p<0.001, p=0.002). Conclusion: In patients with nonvalvular atrial fibrillation and preserved left ventricular ejection fraction, left atrial appendage functions are decreased in patients with left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction may constitute a potential risk for formation of thrombus and stroke. (Anadolu Kardiyol Derg 2014; 14: 256-60

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Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation

Cited by 343 publications

References 21 publications

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

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