[Clinical role of flow velocity of left atrial auricle for prediction of short and long term success of cardioversion in patients with non-valvular atrial fibrillation].
BACKGROUND
Echocardiographic parameters for predicting cardioversion (CV) outcome and long-term sinus rhythm (SR) maintenance in patients with nonvalvular atrial fibrillation (AF) are not accurately defined.


OBJECTIVE
The authors aim was to evaluate the role of left atrial appendage (LAA) flow velocity detected by transesophageal echocardiography before CV for prediction of short and long-term (1 year) outcome of CV in patients with nonvalvular AF.


METHODS
One hundred and nine patients (66 males, mean age: 57 +/- 13 years) with nonvalvular AF lasting more than 48 hours but less than 1-year duration underwent transthoracic and transesophageal echocardiography before either electrical or pharmacological CV attempt.


RESULTS
Cardioversion was successful in restoring SR rhythm in 83 (76%) and unsuccessful in patients 26 (24%). Mean LAA peak emptying flow was higher in patients with successful than in those with unsuccessful CV (36.7 +/- 14.7 vs 26.3 +/- 9.2 cm/sec; p < 0.01). At multivariate analysis the left LAA emptying velocity > 32 cm/sec was the only independent predictor of CV success. Seventy-four out of the 83 patients with successful CV had a complete follow-up of 1 year. At the end of the 1-year follow-up, 40 of the 74 (54%) patients who underwent successful CV preserved the SR. Mean LAA peak emptying velocity was higher in patients remaining in SR for 1 year than in those with AF relapse (40.3 +/- 15.6 vs 32.2 +/- 12.2 cm/sec cm/sec; p < 0.001). On multivariate analysis, only the mean LAA peak emptying velocity > 39 cm/sec and the use of preventive antiarrhythmic drug treatment predicted the continuous preservation of SR during 1 year.


CONCLUSIONS
In patients with nonvalvular AF, measurement of precardioversion LAA flow velocity profile by transesophageal echo cardiography provides valuable information for prediction of both short and long-term success of CV.
Pálinkás
Attila
A
Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, II. sz. Belgyógyászati Klinika és Kardiológiai Központ. palinkasa@hotmail.com
Varga
Albert
A
Nyúzó
Bálint
B
Gruber
Noémi
N
Forster
Tamás
T
Nemes
Attila
A
Horváth
Tamás
T
Fogas
János
J
Boda
Krisztina
K
Sepp
Róbert
R
Hógye
Márta
M
Vass
Andrea
A
Csanády
Miklós
M
D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D001783:Blood Flow Velocity; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000379:methods; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome