Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation

Circ J. 2008 Feb;72(2):256-61. doi: 10.1253/circj.72.256.

Abstract

Background: This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF).

Methods and results: 53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59+/-3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group 2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95% confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4 cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8%).

Conclusion: This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.

MeSH terms

  • Adult
  • Aged
  • Atrial Appendage / diagnostic imaging
  • Atrial Appendage / physiopathology*
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / physiopathology*
  • Atrial Fibrillation / therapy
  • Blood Flow Velocity*
  • Cardiotonic Agents / administration & dosage
  • Chronic Disease
  • Echocardiography, Transesophageal
  • Electric Countershock*
  • Female
  • Follow-Up Studies
  • Humans
  • Isoproterenol / administration & dosage
  • Male
  • Middle Aged
  • Prognosis

Substances

  • Cardiotonic Agents
  • Isoproterenol