Interatrial mechanical dyssynchrony worsened atrial mechanical function in sinus node disease with or without paroxysmal atrial fibrillation.
BACKGROUND
Atrial electromechanical dysfunction might contribute to the development of atrial fibrillation (AF) in patients with sinus node disease (SND). The aim of this study was to investigate the prevalence and impact of atrial mechanical dyssynchrony on atrial function in SND patients with or without paroxysmal AF.


METHODS
We performed echocardiographic examination with tissue Doppler imaging in 30 SND patients with (n = 11) or without (n = 19) paroxysmal AF who received dual-chamber pacemakers. Tissue Doppler indexes included atrial contraction velocities (Va) and timing events (Ta) were measured at midleft atrial (LA) and right atrial (RA) wall. Intraatrial synchronicity was defined by the standard deviation and maximum time delay of Ta among 6 segments of LA (septal/lateral/inferior/anterior/posterior/anterospetal). Interatrial synchronicity was defined by time delay between Ta from RA and LA free wall.


RESULTS
There were no differences in age, P-wave duration, left ventricular ejection fraction, LA volume, and ejection fraction between with or without AF. Patients with paroxysmal AF had lower mitral inflow A velocity (70 +/- 19 vs 91 +/- 17 cm/s, P = 0.005), LA active empting fraction (24 +/- 14 vs 36 +/- 13%, P = 0.027), mean Va of LA (2.6 +/- 0.9 vs 3.4 +/- 0.9 cm/s, P = 0.028), and greater interatrial synchronicity (33 +/- 25 vs 12 +/- 19 ms, P = 0.022) than those without AF. Furthermore, a lower mitral inflow A velocity (Odd ratio [OR]= 1.12, 95% Confidence interval [CI] 1.01-1.24, P = 0.025) and prolonged interatrial dyssynchrony (OR = 1.08, 95% CI 1.01-1.16, P = 0.020) were independent predictors for the presence of AF in SND patients.


CONCLUSIONS
SND patients with paroxysmal AF had reduced regional and global active LA mechanical contraction and increased interatrial dyssychrony as compared with those without AF. These findings suggest that abnormal atrial electromechanical properties are associated with AF in SND patients.
Wang
Mei
M
Division of Cardiology, Department of Medicine, Queen Mary Hospital.
Lau
Chu Pak
CP
Zhang
Xue Hua
XH
Siu
Chung-Wah
CW
Lee
Kathy L F
KL
Yan
Guo Hui
GH
Yue
Wen Sheng
WS
Tse
Hung Fat
HF
D000368:Aged; D001146:Arrhythmia, Sinus / Q000175:diagnosis* / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology*