New Insights Into the Predictors of Left Atrial Stunning After Successful Direct-Current Cardioversion of Atrial Fibrillation and Flutter

Rowlens M. Melduni, Joseph F. Malouf, Krishnaswamy Chandrasekaran, Charles J. Bruce, Roger D. White, Kwan Kin Law, Faisal O. Al Atawi, Virend K. Somers, Bernard J. Gersh, David O. Hodge, Paul A. Friedman, James B. Seward, Naser M. Ammash

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive. Methods: We prospectively evaluated LA and LA appendage function before and immediately after DCCV of atrial fibrillation and atrial flutter in 59 consecutive patients undergoing transesophageal echocardiographically guided DCCV to determine predictors of post-DCCV LAS. Results: After exclusion of patients with pre-DCCV LAS (LA appendage emptying velocity <20 cm/s), post-DCCV LAS was observed in 32 of 45 patients (71%). Only precardioversion mitral E-wave deceleration time significantly correlated with post-DCCV LAS (142 ± 46 vs 170 ± 360 milliseconds; P = .04). At 3.3 years, there was a trend toward a higher arrhythmia recurrence rate in patients with LAS compared with those without (86% vs 53%; P = .063). Conclusion: Only mitral E-wave deceleration time was predictive of post-DCCV LAS, which may be a marker of atrial fibrillation and atrial flutter recurrence.

Original languageEnglish (US)
Pages (from-to)848-854
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume21
Issue number7
DOIs
StatePublished - Jul 1 2008

Keywords

  • Atrial fibrillation
  • Atrial flutter
  • Atrial stunning
  • Cardioversion
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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