Restoration of mechanical atrial function after electrical cardioversion of chronic atrial fibrillation in patients after surgical treatment of mitral valve disease--hemodynamic effects and prognostic value of maintenance of sinus rhythm.
There are controversies regarding the possibility of returning of A wave (mitral flow at left atrial contraction) after electroconversion (EC) in patients with persisting chronic atrial fibrillation in spite of successful surgical treatment of mitral valve disease. Twenty-four hours before successful EC, thereafter daily for 1 week and then on the 14th, 21st and 28th day and 6 months after EC, ECG, M-mode, two-dimensional and Doppler echocardiography were performed in 55 patients. A wave (>0.1 m/s) appeared on the 1st day in 31 patients, on the 2nd day in the next 6, on the 3rd in 5 patients, on the 4th and 5th days in 1 patient and on the 7th day in 4 patients. In 7 patients A wave did not restore. Maximum velocity of A wave increased from 0.48 +/- 0.22 to 0.86 +/- 0.28 m/s (p < 0.05) during the follow-up. In 92% of patients with A wave 24 h after EC, significant increases in stroke index from 35 +/- 12 to 47 +/- 15 ml/m2 (p < 0.04), ejection fraction from 46 +/- 9 to 55 +/- 8% (p < 0.01) and pulmonary acceleration time from 94 +/- 26 to 107 +/- 22 ms (p < 0.05) were observed. Sinus rhythm was still present on the 28th day in 34 patients (62%) and after 6 months in 31 patients (57%), all of them with A wave. observation shows the increase in pulmonary acceleration time, the decrease in the left atrial area and the increase in its systolic function in patients with A wave. Appearance of A wave determined the hemodynamic improvement, but we did not observe a correlation between maximal velocity of A wave and hemodynamic improvement. Appearance of A wave had a low predictive value for maintaining sinus rhythm (sensitivity 58% and specificity 45%). Relative increase in A wave velocity during the 1st week after EC correlated positively with long-term maintenance of sinus rhythm (r = 0.62; p < 0.001).
Szyszka
A
A
Institute of Cardiology, Poznań, Poland.
Trojnarska
O
O
Paluszkiewicz
L
L
Cieśliński
A
A
Ponizyński
A
A
D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D016279:Atrial Function, Left / Q000502:physiology; D004452:Echocardiography; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000502:physiology