title: Effect of low-dose isoproterenol infusion on left atrial appendage function soon after cardioversion of chronic atrial tachyarrhythmias.
abstract: BACKGROUND
  Cardioversion of chronic atrial fibrillation or atrial flutter to sinus rhythm is often associated with transient atrial mechanical dysfunction, i.e. 'atrial stunning', which may increase the risk of subsequent thromboembolic events. We hypothesized that, because of its positive inotropic action, a low-dose isoproterenol infusion might improve postcardioversion atrial mechanical function.
  
  
  METHODS
  Eighteen patients (15 male, three female; 12 atrial fibrillation, six atrial flutter; mean age 65+/-10 years) exhibiting atrial postcardioversion stunning were included in the study. Isoproterenol was infused for 10 min at a dose sufficient to increase the heart rate by about 10%. Using transesophageal echocardiography, both the left atrial appendage emptying/filling flow velocity and function (fractional area change) were examined at baseline, before isoproterenol (immediately after cardioversion) and after isoproterenol.
  
  
  RESULTS
  With infusion of 0.005-0.008 microg/kg/min isoproterenol, heart rate increased by 11.1+/-2.9%, and left atrial appendage emptying velocity, which was diminished following cardioversion, increased significantly (P<0.001) (baseline, before and after isoproterenol: 41.1+/-18.0, 20.3+/-8.5 and 27.3+/-9.6 cm/s, respectively). No major complications were associated with isoproterenol infusion.
  
  
  CONCLUSIONS
  Short-term infusion of low-dose isoproterenol improved atrial function after cardioversion of chronic atrial fibrillation and atrial flutter.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, 105-8461, Tokyo, Japan. datet@jikei.ac.jp
authors.forename: Taro
authors.initials: T
authors.lastname: Date
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Miyazaki
authors.forename: Teiichi
authors.initials: T
authors.lastname: Yamane
authors.forename: Kenji
authors.initials: K
authors.lastname: Noma
authors.forename: Norihito
authors.initials: N
authors.lastname: Nuruiki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kanae
authors.forename: Seibu
authors.initials: S
authors.lastname: Mochizuki
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000187:drug effects*; D001281:Atrial Fibrillation / Q000628:therapy*; D001282:Atrial Flutter / Q000628:therapy*; D016279:Atrial Function, Left / Q000187:drug effects*; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007545:Isoproterenol / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D002316:Cardiotonic Agents; D007545:Isoproterenol