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Comparative Study
. 2005 Jan;91(1):58-63.
doi: 10.1136/hrt.2003.032334.

Acute improvement of atrial mechanical stunning after electrical cardioversion of persistent atrial fibrillation: comparison between biatrial and single atrial pacing

M Takagi  1 , A Doi, N Shirai, K Hirata, Y Takemoto, K Takeuchi, J Yoshikawa
Affiliations
Comparative Study

Acute improvement of atrial mechanical stunning after electrical cardioversion of persistent atrial fibrillation: comparison between biatrial and single atrial pacing

M Takagi et al. Heart. 2005 Jan.

Abstract

Objective: To evaluate the acute effects of atrial pacing at different pacing sites on mechanical stunning after cardioversion of atrial fibrillation (AF).

Setting: Tertiary referral centre.

Patients: 20 patients with persistent AF were studied.

Interventions: Spontaneous echo contrast (SEC), left atrial appendage emptying velocity (LAAEV), and left atrial appendage emptying fraction (LAAEF) were assessed by transoesophageal echocardiography (TOE) during AF, after conversion to sinus rhythm, and during atrial pacing from the right atrial appendage, left lateral atrium, and both atria simultaneously. Transmitral inflow velocity of the atrial wave (TMIF-A) by TOE and the maximum P wave duration in 12 lead ECG were also measured during sinus rhythm and atrial pacing.

Main outcome measures: Comparison of atrial mechanical function and P wave duration in 12 lead ECG during atrial pacing from different sites after cardioversion of AF.

Results: Compared with sinus rhythm, atrial pacing at 80 beats/min increased LAAEV from mean (SD) 14.6 (10.1) to 33.4 (19.8) cm/s (p = 0.001), LAAEF from 13.8 (8.5) to 32.1 (11.2)% (p < 0.001), and TMIF-A from 24.6 (11.9) to 45.6 (21.0) cm/s (p < 0.001) and reduced SEC grade from 2.6 (1.0) to 1.6 (0.9) (p < 0.001). These effects had a positive force-frequency relation. Biatrial pacing produced the shortest P wave duration and resulted in the most significant improvement in atrial function (LAAEV, 33.2 (19.3) v 53.7 (23.9) cm/s, p = 0.0001; LAAEF, 31.9 (11.1) v 46.2 (12.6)%, p < 0.0001; TMIF-A, 37.7 (18.3) v 54.1 (21.2) cm/s, p < 0.001; SEC grade, 1.4 (1.1) v 0.8 (0.9), p = 0.001, right atrial appendage versus biatrial pacing).

Conclusions: Atrial pacing at increased rates can improve atrial mechanical function after cardioversion of persistent AF. Biatrial pacing may be the most effective technique to reverse atrial mechanical stunning.

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Figures

Figure 1
Figure 1
(A) Left atrial appendage emptying velocity (LAAEV) during atrial fibrillation (AF), sinus rhythm (SR) after cardioversion, and atrial pacing at 80, 100, and 120 beats/min. (B) Representative LAAEV.
Figure 2
Figure 2
Left atrial appendage emptying fraction (LAAEF) during AF, SR after cardioversion, and atrial pacing at 80, 100, and 120 beats/min.
Figure 3
Figure 3
(A) Spontaneous echo contrast (SEC) grade during AF, SR after cardioversion, and atrial pacing at 80, 100, and 120 beats/min. (B) Representative SEC during SR and pacing at 120 beats/min.
Figure 4
Figure 4
(A) Transmitral inflow velocity of the atrial wave (TMIF-A) during SR after cardioversion and atrial pacing at 80 beats/min. (B) Representative TMIF-A during SR and pacing at 80 beats/min. A, atrial filling wave; E, early filling wave.
Figure 5
Figure 5
(A) Comparison of LAAEV, LAAEF, TMIF-A, and SEC between right atrial appendage (RAA), lateral coronary sinus (CS), and biatrial pacing (BIA). *p = 0.001, **p<0.001, ***p = 0.0001, ****p<0.0001, RAA v BIA. (B) Representative LAAEV. (C) Representative TMIF-A.
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