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      Restoration of Mechanical Atrial Function after Electrical Cardioversion of Chronic Atrial Fibrillation in Patients after Surgical Treatment of Mitral Valve Disease – Hemodynamic Effects and Prognostic Value of Maintenance of Sinus Rhythm

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          Abstract

          There are controversies regarding the possibility of returning of A wave (mitral flow at left atrial contraction) after electroconversion (EC) in patients with persisting chronic atrial fibrillation in spite of successful surgical treatment of mitral valve disease. Twenty-four hours before successful EC, thereafter daily for 1 week and then on the 14th, 21st and 28th day and 6 months after EC, ECG, M-mode, two-dimensional and Doppler echocardiography were performed in 55 patients. A wave ( > 0.1 m/s) appeared on the 1st day in 31 patients, on the 2nd day in the next 6, on the 3rd in 5 patients, on the 4th and 5th days in 1 patient and on the 7th day in 4 patients. In 7 patients A wave did not restore. Maximum velocity of A wave increased from 0.48 ± 0.22 to 0.86 ± 0.28 m/s (p < 0.05) during the follow-up. In 92% of patiens with A wave 24 h after EC, significant increases in stroke index from 35 ± 12 to 47 ± 15 ml/m<sup>2</sup> (p < 0.04), ejection fraction from 46 ± 9 to 55 ± 8% (p < 0.01) and pulmonary acceleration time from 94 ± 26 to 107 ± 22 ms (p < 0.05) were observed. Sinus rhythm was still present on the 28th day in 34 patients (62%) and after 6 months in 31 patients (57%), all of them with A wave, observation shows the increase in pulmonary acceleration time, the decrease in the left atrial area and the increase in its systolic function in patients with A wave. Appearance of A wave determined the hemodynamic improvement, but we did not observe a correlation between maximal velocity of A wave and hemodynamic improvement. Appearance of A wave had a low predictive value for maintaining sinus rhythm (sensitivity 58% and specificity 45%). Relative increase in A wave velocity during the 1st week after EC correlated positively with long-term maintenance of sinus rhythm (r = 0.62; p < 0.001).

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1996
          1996
          19 November 2008
          : 87
          : 2
          : 98-103
          Affiliations
          Institute of Cardiology, Poznań, Poland
          Article
          177070 Cardiology 1996;87:98–103
          10.1159/000177070
          8653737
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 6
          Categories
          Noninvasive and Diagnostic Cardiology

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