Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation

Young Park Mi, Hee Shin Sung, Jin Oh Woong, Euy Lim Hong, Nam Pak Hui, Sun Lim Do, Hoon Kim Young, Moo Ro Young, Joo Shim Wan

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF). Methods and Results: 53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59±3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95% confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8%). Conclusion: This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.

Original languageEnglish
Pages (from-to)256-261
Number of pages6
JournalCirculation Journal
Volume72
Issue number2
DOIs
Publication statusPublished - 2008 Mar 27

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Atrial Appendage
Electric Countershock
Atrial Fibrillation
Isoproterenol
Transesophageal Echocardiography
Maintenance
Multivariate Analysis
Odds Ratio
Confidence Intervals
Recurrence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Mi, Young Park ; Sung, Hee Shin ; Woong, Jin Oh ; Hong, Euy Lim ; Hui, Nam Pak ; Do, Sun Lim ; Young, Hoon Kim ; Young, Moo Ro ; Wan, Joo Shim. / Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation. In: Circulation Journal. 2008 ; Vol. 72, No. 2. pp. 256-261.
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title = "Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation",
abstract = "Background: This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF). Methods and Results: 53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59±3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95{\%} confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8{\%}). Conclusion: This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.",
author = "Mi, {Young Park} and Sung, {Hee Shin} and Woong, {Jin Oh} and Hong, {Euy Lim} and Hui, {Nam Pak} and Do, {Sun Lim} and Young, {Hoon Kim} and Young, {Moo Ro} and Wan, {Joo Shim}",
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Mi, YP, Sung, HS, Woong, JO, Hong, EL, Hui, NP, Do, SL, Young, HK, Young, MR & Wan, JS 2008, 'Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation', Circulation Journal, vol. 72, no. 2, pp. 256-261. https://doi.org/10.1253/circj.72.256

Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation. / Mi, Young Park; Sung, Hee Shin; Woong, Jin Oh; Hong, Euy Lim; Hui, Nam Pak; Do, Sun Lim; Young, Hoon Kim; Young, Moo Ro; Wan, Joo Shim.

In: Circulation Journal, Vol. 72, No. 2, 27.03.2008, p. 256-261.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation

AU - Mi, Young Park

AU - Sung, Hee Shin

AU - Woong, Jin Oh

AU - Hong, Euy Lim

AU - Hui, Nam Pak

AU - Do, Sun Lim

AU - Young, Hoon Kim

AU - Young, Moo Ro

AU - Wan, Joo Shim

PY - 2008/3/27

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N2 - Background: This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF). Methods and Results: 53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59±3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95% confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8%). Conclusion: This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.

AB - Background: This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF). Methods and Results: 53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59±3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95% confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8%). Conclusion: This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.

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