Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation

Antonielli, E; Pizzuti, A; Bassignana, Antonia; Tanga, M; Baralis, Giorgio; Rovere, Maria Elena; Leo, Margherita Di

doi:10.1016/s0002-9149(99)00508-1

Cited by 53 publications

(23 citation statements)

References 14 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: 80%

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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: 80%

“…[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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“…722 There is no evidence, however, that cardioversion followed by prolonged maintenance of sinus rhythm effectively reduces thromboembolism in AF patients. Conversion of AF to sinus rhythm results in transient mechanical dysfunction of the LA and LAA 417 known as "stunning," which can occur after spontaneous, pharmacological, 723,724 or electrical 724 -726 conversion of AF or after radiofrequency catheter ablation of atrial flutter 226 and which may be associated with SEC. 417 Recovery of mechanical function may be delayed for several weeks, depending in part on the duration of AF before conversion.…”

Section: Type III Antiarrhythmic Agentsmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,877

589

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“…There is no evidence, however, that cardioversion followed by prolonged maintenance of sinus rhythm effectively reduces thromboembolism in AF patients. Conversion of AF to sinus rhythm results in transient mechanical dysfunction of the LA and LAA 286 ("stunning"), which can occur after spontaneous, pharmacological, 287,288 or electrical 288 -290 conversion of AF or after radiofrequency catheter ablation of atrial flutter. 91 Recovery of mechanical function may be delayed, depending in part on the duration of AF before conversion.…”

Section: Prevention Of Thromboembolism In Patients With Atrial Fibmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

264

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Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation

Cited by 53 publications

References 14 publications

Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

Reversal of Atrial Mechanical Stunning After Cardioversion of Atrial Arrhythmias

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

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