Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation.
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.
Park
Mi Young
MY
Department of Cardiology, Sejong General Hospital, 126-1, 5ka Anamdong,Sungbuk-ku, Seoul 136-705, Korea. wjshimmd@unitel.co.kr
Shin
Sung Hee
SH
Oh
Woong Jin
WJ
Lim
Hong Euy
HE
Pak
Hui Nam
HN
Lim
Do Sun
DS
Kim
Young Hoon
YH
Ro
Young Moo
YM
Shim
Wan Joo
WJ
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
D002316:Cardiotonic Agents; D007545:Isoproterenol