title: Electromechanical delay detected by tissue Doppler echocardiography is associated with the frequency of attacks in patients with lone atrial fibrillation.
abstract: BACKGROUND
  Our main purpose in this study is to compare atrial (inter-atrial, intra-left atrial, intra-right atrial) electromechanical delays of patients with lone atrial fibrillation (LAF) with healthy individuals and examine the relationship of annual LAF attack frequency.
  
  
  METHODS
  32 entirely healthy individuals and 32 patients who have presented with tachycardia and complying with LAF criteria have been included in the study. The time passing from the beginning of the P wave on electrocardiography to the A' wave on tissue Doppler trace was accepted as the atrial conduction time (PA'). The PA' time difference between the mitral annulus of left ventricle (ML) and the tricuspid annulus of right ventricle (TL) was defined as inter-atrial electromechanical delay (IA-EMD), the PA' time difference between the ML and septal mitral annulus (MS) as intra-left electromechanical delay (ILeft-EMD), the PA' time difference between MS and the TL as intra-right electromechanical delay (IRight-EMD).
  
  
  RESULTS
  ILeft-EMD (21.8 ± 9.1 vs. 14.1 ± 4.9, p < 0.001), IRight-EMD (9.3 ± 6.8 vs. 5.9 ± 4.9, p = 0.03) and IA-EMD times (24.7 ± 11.2 vs. 11.9 ± 7.1, p < 0.001) were significantly longer in LAF patients. In multivariate regression analysis, using a model including age, gender and left atrium (LA) volumes, ILeft-EMD times (OR 1.14, 95% CI 1.03-1.27,p = 0.012), IA-EMD times (OR 1.12, 95% CI 1.03-1.23, p = 0.007) and LA volumes (OR 1.18, 95% CI 1.05-1.32, p = 0.005) were independent predictors of LAF. In LAF group, the frequency of AF episodes was significantly correlated with ILeft-EMD (r = 0.90, p < 0.001) and IA-EMD times (r = 0.36, p < 0.004), whereas, IRight-EMD times and LA volumes were not correlated with recurrence rates.
  
  
  CONCLUSIONS
  ILeft-EMD and IA-EMD may increase in the early stages of atrial fibrillation even without the left atrial dilation and may be more valuable than left atrial area and volume in predicting atrial fibrillation.
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Sur gery Center, Istanbul, Turkey. calik_nazmi@hotmail.com.
authors.forename: Ali Nazmi
authors.initials: AN
authors.lastname: Calık
authors.forename: Kazım Serhan
authors.initials: KS
authors.lastname: Ozcan
authors.forename: Metin
authors.initials: M
authors.lastname: Cağdaş
authors.forename: Barış
authors.initials: B
authors.lastname: Güngör
authors.forename: Gürkan
authors.initials: G
authors.lastname: Karaca
authors.forename: Ufuk
authors.initials: U
authors.lastname: Gürkan
authors.forename: Hale
authors.initials: H
authors.lastname: Yılmaz
authors.forename: Osman
authors.initials: O
authors.lastname: Bolca
mesh_terms: D000200:Action Potentials; D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016279:Atrial Function, Left; D016280:Atrial Function, Right; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right