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• W2013156620 abstract "Electrical cardioversion (ECV) of atrial fibrillation to normal sinus rhythm (NSR) is associated with an increased risk of stroke presumably from left atrial mechanical “stunning” and subsequent stasis of blood. The effect of ineffective electrical shocks on the mechanical function of the left atrium and the formation or worsening of spontaneous contrast is unknown. We studied 16 pts with atrial fibrillation (> 2 days) pre and post each ECV attempt during continuous transesophageal echocardiography. ECV was performed at 50, 100, 200, then 360J until NSR was achieved. Group 1 (N = 7) required 50J and group 2 (N = 9) > 50J for conversion to NSR. Left atrial appendage emptying (LA-EV) and filling velocities (LA-FV) were measured (m/sec) with pulsed wave Doppler and spontaneous contrast was graded visually pre- and post- each ECV attempt.Empty CellLA-EVEmpty Cellpre50J100JNSRall pts0.41 ± 0.12→→0.28 ± 0.16*grp 10.42 ± 0.110.25 ± 0.15*→0.25 ± 0.15*grp 20.40 ± 0.140.36 ± 0.150.60 ± 0.230.28 ± 0.17LA-FVpre50J100JNSRall pts0.47 ± 0.18→→0.33 ± 0.14*grp 10.44 ± 0.080.30 ± 0.15*→0.30 ± 0.15*grp 20.47 ± 0.230.42 ± 0.150.39 ± 0.160.33 ± 0.15*pre vs NSR, p < 0.05 pre vs NSR, p < 0.05 There was a trend to a decrease in LA-EV and LA-FV post-conversion to NSR (p < 0.05 for group 1 and all pts combined). The left ventricular ejection fractions pre-ECV were not significantly different between groups (55 ± 11% vs 46 ± 9%, p = NS). Spontaneous contrast was present in 6 pts in group 1 (86%) and 4 pts in group 2 (44%) at baseline and worsened in 1 pt in group 1 (14%) and 3 pts in group 2 (33%) only after conversion to NSR. One pt in group 1 and 3 pts in group 2 had no spontaneous contrast at baseline and developed it only after conversion to NSR. 1) Decreased left atrial mechanical function occurs after conversion to NSR. 2) Left atrial mechanical function is not significantly decreased after ineffective ECV attempts. 3) Spontaneous contrast was found more often in pts requiring less energy for cardioversion. 4) Spontaneous contrast worsened more often in pts requiring more energy for conversion to NSR and worsened only after conversion to NSR. 5) These findings suggest that left atrial “stunning” and worsening stasis of flow is due to conversion to NSR and not secondary to ineffective ECV attempts." @default.
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• W2013156620 date "1995-02-01" @default.
• W2013156620 modified "2023-09-27" @default.
• W2013156620 title "754-6 Continuous Transesophageal Echocardiography During Sequential Electrical Cardioversion Attempts for Atrial Fibrillation: Effect on Left Atrial Appendage Function and Spontaneous Contrast Formation" @default.
• W2013156620 doi "https://doi.org/10.1016/0735-1097(95)92419-6" @default.
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