Skip Navigation

European Heart Journal 2001 22(23):2201-2208; doi:10.1053/euhj.2001.2891
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (17)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Pálinkás, A.
Right arrow Articles by Csanády, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pálinkás, A.
Right arrow Articles by Csanády, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation

A. Pálinkása, E. Antoniellib, E. Picanoc, A. Pizzutid, A. Vargaa, B. Nyúzóa, J.M. Alegretc, A. Bonzanod, M. Tangab, A. Coppolinob, T. Forstera, G. Baralisb, F. Delnevod and M. Csanádya

a 2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical Faculty, University of Sciences, Szeged, Hungary
b Divisione di Cardiologia, Ospedale SS. Annunziata, Savigliano, Italy
d Divisione di Cardiologia, Ospedale, Mauriziano, Umberto I, Torino, Italy
c CNR, Institute of Clinical Physiology, Pisa, Italy

revised July 10, 2001; accepted July 11, 2001

Abstract

Background Echocardiographic parameters for predicting cardioversion outcome in patients with non-valvular atrial fibrillation are not accurately defined.

Objective To evaluate the role of left atrial appendage flow velocity detected by transoesophageal echocardiography for prediction of cardioversion outcome in patients with non-valvular atrial fibrillation enrolled in a prospective, multicentre, international study.

Methods Four hundred and eight patients (257 males, mean age: 66±10 years) with non-valvular atrial fibrillation lasting more than 48h but less than 1 year underwent transthoracic echocardiography and transoesophageal echocardiography before either electrical (n=324) or pharmacological (n=84) cardioversion.

Results Cardioversion was successful in restoring sinus rhythm in 328 (80%) and unsuccessful in 80 patients (20%). Mean left atrial appendage peak emptying flow velocity was significantly higher in patients with successful than in those with unsuccessful cardioversion (32·4±17·7 vs 23·5±13·6cm.s–1;P<0·0001). At multivariate logistic regression analysis, three parameters proved to be independent predictors of cardioversion success: the atrial fibrillation duration <2 weeks (P=0·011, OR=4·9, CI 95%= 1·9–12·7), the mean left atrial appendage flow velocity >31cm.s–1(P=0·0013, OR=2·8, CI 95%=1·5–5·4) and the left atrial diameter <47mm (P=0·093, OR=2·0, CI 95%=1·2–3·4). These independent predictors of cardioversion success outperformed other univariate predictors such as left ventricular end-diastolic diameter <58mm, ejection fraction >56% and the absence of left atrial spontaneous echo contrast.

Conclusion In patients with non-valvular atrial fibrillation, measurement of the left atrial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardioversion outcome.

Key Words: Transoesophageal echocardiography, atrial fibrillation, cardioversion

Correspondence: Eugenio Picano, MD, PhD, FESC, Institute of Clinical Physiology, Pisa, CNR, Via Moruzzi, 1, 56100 PISA-Italy.

References

  1. Brodsky MA, Allen BJ, Capparelli EV, Luckett CR, Morton R, Henry WL. Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation. Am J Cardiol. 1989;63:1065–1068[CrossRef][ISI][Medline]
  2. Henry, WL, Morganroth, J, Pearlman, AS, Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation, 1976, 53, 273, 9
  3. Dittrich HC, Erickson JS, Schneiderman T, Blacky AR, Savides T, Nicod PH. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol. 1989;63:193–197[CrossRef][ISI][Medline]
  4. Tracy CM, Akhtar M, DiMarco JP, Packer DL, Weitz HH. American College of Cardiology/American Heart Association clinical competence statement on invasive electrophysiology studies, catheter ablation, and cardioversion. A report of the American College of Cardiology/American Heart Association/American College of Physicians—American Society of Internal Medicine Task Force on clinical competence. J Am Coll Cardiol. 2000;36:1725–1736[Free Full Text]
  5. Manning WJ, Silverman DI, Gordon SP, Krumholz HM, Douglas PS. Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med. 1993;328:750–755[Abstract/Free Full Text]
  6. Klein AL, Murray DR, Grimm RA. Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation. J Am Coll Cardiol. 2001;37:691–704[Abstract/Free Full Text]
  7. Labovitz AJ, Bransford TL. Evolving role of echocardiography in the management of atrial fibrillation. Am Heart J. 2001;141:518–527[CrossRef][ISI][Medline]
  8. Kamp O, Verhorst PM, Welling RC, Visser CA. Importance of left atrial appendage flow as a predictor of thromboembolic events in patients with atrial fibrillation. Eur Heart J. 1999;20:979–985[Abstract/Free Full Text]
  9. Agmon Y, Khandheria BK, Gentile F, Seward JB. Echocardiographic assessment of the left atrial appendage. J Am Coll Cardiol. 1999;34:1867–1877[Abstract/Free Full Text]
  10. Ann Int Med. 1998;128:639–647[Abstract/Free Full Text]
  11. Mitusch R, Garbe M, Schmucker G, Schwabe K, Stierle U, Sheikhzadeh A. Relation of left atrial appendage function to the duration and reversibility of nonvalvular atrial fibrillation. Am J Cardiol. 1995;75:944–947[CrossRef][ISI][Medline]
  12. Tabata T, Oki T, Iuchi A. Evaluation of left atrial appendage function by measurement of changes in flow velocity patterns after electrical cardioversion in patients with isolated atrial fibrillation. Am J Cardiol. 1997;79:615–620[CrossRef][ISI][Medline]
  13. Perez Y, Duval AM, Carville C. Is left atrial appendage flow a predictor for outcome of cardioversion of nonvalvular atrial fibrillation? A transthoracic and transesophageal echocardiographic study. Am Heart J. 1997;134:745–751[CrossRef][ISI][Medline]
  14. Verhorst PM, Kamp O, Welling RC, Van Eenige MJ, Visser CA. Transesophageal echocardiographic predictors for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. Am J Cardiol. 1997;79:1355–1359[CrossRef][ISI][Medline]
  15. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–1083[Abstract/Free Full Text]
  16. Mügge A, Daniel WG, Hausman D, Gödke J, Wagenbreth I, Lichtlen PR. Diagnosis of left atrial appendage thrombi by transesophageal echocardiography: clinical implication and follow-up. Am J Cardiac Imaging. 1990;4:173–179
  17. Daniel W, Nellensen U, Schröder E. Left atrial spontaneous echo contrast in mitral valve disease: an indicator for an increased thromboembolic risk. J Am Coll Cardiol. 1988;11:1204–1211[Abstract]
  18. Yoshida K, Yoshikawa J, Yamaura Y, Hozumi T, Akasaka T, Fukaya T. Assessment of mitral regurgitation by biplane transesophageal color Doppler flow mapping. Circulation. 1990;82:1121–1126[Abstract/Free Full Text]
  19. Van Gelder IC, Crijns HJ, Van Gilst WH, Verwer R, Lie KI. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol. 1991;68:41–46[ISI][Medline]
  20. Singh S, Zoble RG, Yellen L. Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: the symptomatic atrial fibrillation investigative research on dofetilide (SAFIRE-D) study. Circulation. 2000;102:2385–2390[Abstract/Free Full Text]
  21. Li YH, Lai LP, Shyu KG, Hwang JJ, Kuan P, Lien WP. Clinical implications of left atrial appendage flow patterns in nonrheumatic atrial fibrillation. Chest. 1994;105:748–752[Abstract/Free Full Text]
  22. Fatkin D, Kelly R, Feneley M. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23:961–969[Abstract]
  23. Chugh SS, Blackshear JL, Shen WK, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol. 2001;37:371–378[Abstract/Free Full Text]
  24. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994;74:236–241[CrossRef][ISI][Medline]
  25. Pollick C, Taylor D. Assessment of left atrial appendage function by transoesophageal echocardiography: implications for the development of thrombus. Circulation. 1991;84:223–231[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
M. Strandberg, M.J. P. Raatikainen, M. Niemela, M. Luotolahti, J. Hartiala, and K.E. J. Airaksinen
Clinical practicality and predictive value of transoesophageal echocardiography in early cardioversion of atrial fibrillation
Europace, June 1, 2006; 8(6): 408 - 412.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
E. Donal, H. Yamada, C. Leclercq, and D. Herpin
The Left Atrial Appendage, a Small, Blind-Ended Structure: A Review of Its Echocardiographic Evaluation and Its Clinical Role
Chest, September 1, 2005; 128(3): 1853 - 1862.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
I. A. Paraskevaidis, T. Dodouras, D. Tsiapras, and D. T. Kremastinos
Prediction of Successful Cardioversion and Maintenance of Sinus Rhythm in Patients With Lone Atrial Fibrillation
Chest, February 1, 2005; 127(2): 488 - 494.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
E. Antonielli, A. Pizzuti, A. Palinkas, M. Tanga, N. o. Gruber, C. Michelassi, A. Varga, A. Bonzano, N. Gandolfo, L.a. Halmai, et al.
Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation
J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1443 - 1449.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (17)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Pálinkás, A.
Right arrow Articles by Csanády, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pálinkás, A.
Right arrow Articles by Csanády, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?