title: Tissue velocity imaging of the left atrium predicts response to flecainide in patients with acute atrial fibrillation.
abstract: BACKGROUND
  Acute atrial fibrillation (AF) is often treated with the administration of intravenous flecainide; however, this treatment may not always be successful and is potentially hazardous. Previous studies suggest that electro-echocardiographic tissue velocity imaging (TVI) of the atrial wall may reflect atrial remodeling.
  
  
  OBJECTIVE
  To study whether atrial TVI can be used to identify nonresponders of flecainide administered intravenously in patients with acute AF.
  
  
  METHODS
  We used atrial TVI to measure atrial fibrillatory cycle length determined by using tissue velocity imaging (AFCL-TVI) and atrial fibrillatory wall motion velocity determined by using tissue velocity imaging (AFV-TVI) in the left atrium in 52 (55%) patients presenting with acute AF in the emergency department. These 2 parameters reflect electrical and structural remodeling, respectively. Standard baseline characteristics were recorded.
  
  
  RESULTS
  Patients were predominantly men (76%) and 64 ± 11 years old. Thirty-six (69%) patients had successful cardioversion after flecainide infusion. There were no significant differences in baseline characteristics between responders and nonresponders. Patients with a successful cardioversion had a longer mean AFCL-TVI and higher median (interquartile range) AFV-TVI compared with patients with failed cardioversion: 172 ± 29 ms vs 137 ± 35 ms (P < .001) and 4.2 (3.3-6.2) cm/s vs 2.3 (1.9-3.5) cm/s (P = .001).
  
  
  CONCLUSIONS
  Electro-echocardiographic atrial TVI measurement is a promising noninvasive tool for predicting outcome of pharmacological cardioversion. A short AFCL-TVI and a low AFV-TVI are related to failure of cardioversion of AF using flecainide.
authors: Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: ione.limantoro@gmail.com.
authors: Ione
authors: I
authors: Limantoro
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Cees B
authors: CB
authors: De Vos
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Tammo
authors: T
authors: Delhaas
authors: University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Ernaldo
authors: E
authors: Marcos
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Yuri
authors: Y
authors: Blaauw
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Bob
authors: B
authors: Weijs
authors: Martini Hospital Groningen, Groningen, The Netherlands.
authors: Robert G
authors: RG
authors: Tieleman
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Ron
authors: R
authors: Pisters
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Ulrich
authors: U
authors: Schotten
authors: University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Isabelle C
authors: IC
authors: Van Gelder
authors: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Harry J G M
authors: HJ
authors: Crijns
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005424:Flecainide / Q000008:administration & dosage / Q000627:therapeutic use*; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D005424:Flecainide
keywords: Atrial fibrillation; Echocardiography; Flecainide; Pharmacological cardioversion; Tissue Velocity Imaging