title: New insights into the predictors of left atrial stunning after successful direct-current cardioversion of atrial fibrillation and flutter.
abstract: BACKGROUND
  Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive.
  
  
  METHODS
  We prospectively evaluated LA and LA appendage function before and immediately after DCCV of atrial fibrillation and atrial flutter in 59 consecutive patients undergoing transesophageal echocardiographically guided DCCV to determine predictors of post-DCCV LAS.
  
  
  RESULTS
  After exclusion of patients with pre-DCCV LAS (LA appendage emptying velocity <20 cm/s), post-DCCV LAS was observed in 32 of 45 patients (71%). Only precardioversion mitral E-wave deceleration time significantly correlated with post-DCCV LAS (142 +/- 46 vs 170 +/- 360 milliseconds; P = .04). At 3.3 years, there was a trend toward a higher arrhythmia recurrence rate in patients with LAS compared with those without (86% vs 53%; P = .063).
  
  
  CONCLUSIONS
  Only mitral E-wave deceleration time was predictive of post-DCCV LAS, which may be a marker of atrial fibrillation and atrial flutter recurrence.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. melduni.rowlens@mayo.edu
authors.forename: Rowlens M
authors.initials: RM
authors.lastname: Melduni
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Chandrasekaran
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bruce
authors.forename: Roger D
authors.initials: RD
authors.lastname: White
authors.forename: Kwan-Kin
authors.initials: KK
authors.lastname: Law
authors.forename: Faisal O
authors.initials: FO
authors.lastname: Al Atawi
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: James B
authors.initials: JB
authors.lastname: Seward
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001282:Atrial Flutter / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004554:Electric Countershock / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors