Article

New insights into the predictors of left atrial stunning after successful direct-current cardioversion of atrial fibrillation and flutter.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography (impact factor: 2.98). 08/2008; 21(7):848-54. DOI:10.1016/j.echo.2007.12.001 pp.848-54
Source: PubMed

ABSTRACT Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive.
We prospectively evaluated LA and LA appendage function before and immediately after DCCV of atrial fibrillation and atrial flutter in 59 consecutive patients undergoing transesophageal echocardiographically guided DCCV to determine predictors of post-DCCV LAS.
After exclusion of patients with pre-DCCV LAS (LA appendage emptying velocity <20 cm/s), post-DCCV LAS was observed in 32 of 45 patients (71%). Only precardioversion mitral E-wave deceleration time significantly correlated with post-DCCV LAS (142 +/- 46 vs 170 +/- 360 milliseconds; P = .04). At 3.3 years, there was a trend toward a higher arrhythmia recurrence rate in patients with LAS compared with those without (86% vs 53%; P = .063).
Only mitral E-wave deceleration time was predictive of post-DCCV LAS, which may be a marker of atrial fibrillation and atrial flutter recurrence.

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Keywords

45 patients
 
59 consecutive patients undergoing transesophageal echocardiographically
 
atrial fibrillation
 
Direct-current cardioversion
 
higher arrhythmia recurrence rate
 
LA
 
LA appendage emptying velocity <20 cm/s
 
LA appendage function
 
LAS
 
LAS determinants
 
mitral E-wave deceleration time
 
patients
 
post-DCCV LAS
 
potentiate thromboembolic complications
 
pre-DCCV LAS