title: Acute changes in spontaneous echo contrast and atrial function after cardioversion of persistent atrial flutter.
abstract: With use of transesophageal echocardiography, the short-term effects of transthoracic electrical cardioversion of atrial flutter (AFI) on atrial mechanical function and spontaneous echo contrast were determined. Thirty patients who had AFI for a mean of 6.4 +/- 12.2 months underwent transthoracic cardioversion. A transesophageal echocardiogram was recorded immediately before cardioversion, and left atrial appendage emptying velocity and spontaneous contrast were assessed serially at 1, 3, and 5 minutes after cardioversion in 28 patients, and also at 8, 10, and 15 minutes after cardioversion in a subgroup of 13 patients. Cardioversion was deferred in 2 patients (7%) because a thrombus was found in the left atrial appendage. Before cardioversion, spontaneous contrast was present in the left atrium in 7 of 28 patients (25%) who underwent cardioversion. The mean left atrial appendage emptying velocity of 54 +/- 22 cm/s before cardioversion fell by 26% to 40 +/- 25 cm/s at 1 minute after restoration of sinus rhythm (p <0.01). There were no significant changes in the mean left atrial appendage-emptying velocity between 1 and 15 minutes after cardioversion. Within 5 minutes after conversion to sinus rhythm, left atrial spontaneous echo contrast developed de novo or worsened in 12 of the 28 patients (43%). In conclusion, the results of this study demonstrate that persistent AFI may be associated with left atrial thrombi before cardioversion and that cardioversion of AFI is associated with a significant degree of atrial stunning and formation of spontaneous echo contrast.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022, USA.
authors.forename: R
authors.initials: R
authors.lastname: Weiss
authors.forename: P
authors.initials: P
authors.lastname: Marcovitz
authors.forename: B P
authors.initials: BP
authors.lastname: Knight
authors.forename: M
authors.initials: M
authors.lastname: Bahu
authors.forename: J J
authors.initials: JJ
authors.lastname: Souza
authors.forename: A
authors.initials: A
authors.lastname: Zivin
authors.forename: R
authors.initials: R
authors.lastname: Goyal
authors.forename: E G
authors.initials: EG
authors.lastname: Daoud
authors.forename: K C
authors.initials: KC
authors.lastname: Man
authors.forename: S A
authors.initials: SA
authors.lastname: Strickberger
authors.forename: W F
authors.initials: WF
authors.lastname: Armstrong
authors.forename: F
authors.initials: F
authors.lastname: Morady
mesh_terms: D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy*; D016279:Atrial Function, Left; D002908:Chronic Disease; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies