Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

Sanders, Prashanthan; Morton, Joseph B.; Morgan, John G.; Davidson, Neil C.; Spence, S.; Vohra, Jitendra K.; Kalman, Jonathan M.; Sparks, Paul B.

doi:10.1161/01.cir.0000032262.31520.e5

Cited by 38 publications

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References 35 publications

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“…We have previously demonstrated, after the cardioversion of chronic atrial flutter in humans (median 4 months), significant improvement and reversal of atrial mechanical stunning with increasing atrial pacing rates, isoproterenol, and calcium. 6 In the present study, in patients with AF, there was a significant increase in LAAEV and reduction in LASEC during AF with the use of isoproterenol. These findings are similar to previous observations with the use of dobutamine during AF.…”

Section: Atrial Mechanical Function During Af and After Cardioversionsupporting

confidence: 52%

“…The study was designed prospectively, requiring 11 patients in each group to demonstrate a 10.0Ϯ8.3-cm/s increase in peak LAAEV achieved through pacing with 80% power. 6 …”

Section: Discussionmentioning

confidence: 99%

“…We have previously extended these observations to the whole atrium in a clinical study of patients with atrial mechanical stunning after the cardioversion of chronic atrial flutter by radiofrequency ablation. 6 After the development of atrial mechanical stunning in these patients, atrial mechanical dysfunction could be reversed acutely with increased stimulation rates, calcium, and isoproterenol, demonstrating a positive force-frequency relationship. 6 However, chronic AF is likely to be associated with structural remodeling and fibrosis that would be expected to contribute to atrial mechanical dysfunction.…”

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confidence: 89%

“…6 After the development of atrial mechanical stunning in these patients, atrial mechanical dysfunction could be reversed acutely with increased stimulation rates, calcium, and isoproterenol, demonstrating a positive force-frequency relationship. 6 However, chronic AF is likely to be associated with structural remodeling and fibrosis that would be expected to contribute to atrial mechanical dysfunction. 7,8 Whether atrial mechanical dysfunction because of AF can be reversed is unknown.…”

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confidence: 89%

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Reversal of Atrial Mechanical Dysfunction After Cardioversion of Atrial Fibrillation

et al. 2003

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Background-Atrial mechanical "stunning" develops after cardioversion of atrial fibrillation (AF) and is implicated in the genesis of thromboembolic complications. However, the mechanisms responsible for this phenomenon are poorly understood. Whether atrial mechanical dysfunction caused by AF can be reversed by pacing at increased rates or by pharmacological agents is unknown. Methods and Results-Twenty-six patients with AF undergoing cardioversion were dichotomized prospectively on the basis of the duration of arrhythmia as short-duration (1 to 6 months) or long-duration (Ն3 years) AF. Left atrial appendage emptying velocities (LAAEVs) and spontaneous echocardiographic contrast (LASEC) were assessed by transesophageal echocardiography during AF, after reversion to sinus rhythm, during atrial pacing at cycle lengths of 750 to 250 ms, after a postpacing pause, and with isoproterenol. short-duration AF. In contrast, long-duration AF is associated with an attenuated response to these maneuvers. These findings suggest a functional contractile apparatus in the mechanically remodeled atrium caused by AF; however, with longer durations of AF, additional factors may determine atrial mechanical function.

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Section: Atrial Mechanical Function During Af and After Cardioversionsupporting

confidence: 52%

“…The study was designed prospectively, requiring 11 patients in each group to demonstrate a 10.0Ϯ8.3-cm/s increase in peak LAAEV achieved through pacing with 80% power. 6 …”

Section: Discussionmentioning

confidence: 99%

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confidence: 89%

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confidence: 89%

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Reversal of Atrial Mechanical Dysfunction After Cardioversion of Atrial Fibrillation

et al. 2003

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“…After typical AFl ablation the RA becomes smaller and improves its contractility suggesting a component of atrial tachymyocardiopathy after cardioversion of atrial tachyarrhythmia [17]. It is possible that these structural and functional changes after arrhythmia ablation and sinus rhythm restoration occur due to a component of tachymyocardiopathy, as occur in the left ventricle.…”

Section: Follow-up Studymentioning

confidence: 99%

Echocardiographic Biatrial Remodelling and Diastolic Function Assessment in Long-Term Follow-Up after Typical Atrial Flutter Ablation

Cabanas‐Grandío¹

2014

J Cardiovasc Med Cardiol

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Background: A reverse left atrial (LA) remodelling after atrial fibrillation (AF) ablation has been reported and a relationship between diastolic function and AF is well known. However, there is little information about atrial remodelling and diastolic function after cavotricuspid isthmus (CTI) ablation. We aimed to evaluate long-term biatrial remodelling and diastolic function in patients undergoing CTI ablation. Methods:A transthoracic echocardiography was performed at baseline and at longterm follow-up (6.3 ± 0.5 years) in a total of 39 patients who underwent AFl ablation. Right atrial end diastolic areas (RAEDA) and end systolic areas (RAESA), right atrial contraction fraction (RACF), mitral A wave velocity, E/A rate and LA diameter were measured. They were compared using the Wilcoxon rank sum test.Results: Mean (SD) age was 64 (10) years, 82% male, 49% hypertension and 44% prior AF episodes. Basal RAEDA and RAESA were higher than at follow-up: median (IQR) of 24.6 cm² (19.8-28.2) vs. 20.0 cm² (16.0-25.0), p = 0.017 and 17.4 cm² (13.0-19.3) vs. 12.0 cm² (9.8-17.0), p = 0.001, respectively. RACF was higher at follow-up: 0.41 (0.35-0.45) vs. 0.31 (0.19-0.37), p = 0.001. Basal mitral A wave velocity was lower than at follow-up: 0.51 (0.4-0.6) vs. 0.78 (0.7-0.9), p =0.001 and E/A rate was higher 1.9 (1.2-3.1) vs. 0.9 (0.7-1.1), p = 0.001. LA diameter at baseline was 44.8 mm (39.3-50.7) vs. 46 mm (41.5-51.5) at follow-up, p <0.001. Conclusion:AFl ablation led to reverse remodelling of the right atrium and improved diastolic dysfunction parameters in the long-term follow-up.limited studies suggest that AFl ablation also favours LA function recovery, as occurs after AF ablation [7]. However, there is no information about right atrial (RA) and LA anatomical remodelling in the long term follow-up after AFl ablation. Our objective was to investigate echocardiographic biatrial remodelling and diastolic function in the long-term follow-up after cavotricuspid isthmus (CTI) ablation. Methods Study populationWe included 39 patients who had undergone typical AFl ablation between January 2003 and May 2005 in which a complete echocardiographic study was performed at baseline (first 6 hours after ablation procedure) and at follow-up (mean ± SD of 6.3 ± 0.5 years) to assess echocardiographic remodelling.All patients included were over 18 years, with at least one episode of documented AFl in the previous 6 months, and demonstrated a CTI-dependent AFl during electrophysiological study, or CTI permeability with an electrocardiogram suggestive of typical AFl, in cases where the procedure was performed in sinus rhythm. IntroductionAtrial fibrillation (AF) is the most common arrhythmia seen in clinical practice and it is well-known that there is a relationship between AF and diastolic function [1]. It is also known that LA function is recovered after cardioversion to sinus rhythm as well as after AF ablation, and a reverse LA remodelling after AF ablation has also been reported [2][3][4][5]. ISSN: 2455-2976Citation: Cabanas...

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Atrial Plasticity

Sanders¹,

Morton²,

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et al. 2005

Innovative Management of Atrial Fibrillation

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Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

Cited by 38 publications

References 35 publications

Reversal of Atrial Mechanical Dysfunction After Cardioversion of Atrial Fibrillation

Reversal of Atrial Mechanical Dysfunction After Cardioversion of Atrial Fibrillation

Echocardiographic Biatrial Remodelling and Diastolic Function Assessment in Long-Term Follow-Up after Typical Atrial Flutter Ablation

Atrial Plasticity

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