title: Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation.
abstract: BACKGROUND
  This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF).
  
  
  RESULTS
  53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59+/-3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group 2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95% confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4 cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8%).
  
  
  CONCLUSIONS
  This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.
authors.affiliation: Department of Cardiology, Sejong General Hospital, 126-1, 5ka Anamdong,Sungbuk-ku, Seoul 136-705, Korea. wjshimmd@unitel.co.kr
authors.forename: Mi Young
authors.initials: MY
authors.lastname: Park
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Shin
authors.forename: Woong Jin
authors.initials: WJ
authors.lastname: Oh
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.forename: Hui Nam
authors.initials: HN
authors.lastname: Pak
authors.forename: Do Sun
authors.initials: DS
authors.lastname: Lim
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Young Moo
authors.initials: YM
authors.lastname: Ro
authors.forename: Wan Joo
authors.initials: WJ
authors.lastname: Shim
mesh_terms: D000328:Adult; D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D001783:Blood Flow Velocity; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D002316:Cardiotonic Agents; D007545:Isoproterenol