Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Feb 2;4(5):463.
doi: 10.4022/jafib.463. eCollection 2012 Feb-Mar.

Role of Echocardiography in the Management and Prognosis of Atrial Fibrillation

David I Silverman  1 , Srilatha R Ayirala  1 , Warren J Manning  1
Affiliations
Review

Role of Echocardiography in the Management and Prognosis of Atrial Fibrillation

David I Silverman et al. J Atr Fibrillation. .

Abstract

Echocardiography plays a longstanding and vital role in the management of atrial fibrillation (AF). Advances in 2D imaging, Doppler echocardiography and strain imaging have all contributed to major progress in AF treatment. Echocardiographically measured left atrial (LA) volume is a powerful predictor of maintenance of sinus rhythm following cardioversion as well as risk of thrombus formation and thromboembolism. Doppler derived parameters of atrial mechanical function including atrial ejection force provide related prognostic information. Transesophageal echocardiocardiograpy (TEE) guided cardioversion of AF allows for rapid conversion to sinus rhythm without prolonged oral anticoagulation, and TEE serves as a useful tool during catheter ablation of AF and atrial flutter. Newer measures derived from speckle tracking offer great promise in further improving the care of patients with AF.

PubMed Disclaimer

Figures

Figure 1a.
Figure 1a.. The anteroposterior dimension (D1) obtained in the parasternal long axis view is used for the ellipsoidal estimation of left atrial (LA) volume.
Figure 1b.
Figure 1b.. The LA minor dimension (D2) and LA length from the roof of the atrium length (D3) obtained in the apical 4-chamber view complete the 3 axes required for the calculation; (4π/3) (L/2)(D1/2)(D2/2)
Figure 2a.
Figure 2a.. LA volume calculated using the method of discs (Simpson’s rule) in the apical 4-chamber view. The calculation is performed using automated software.
Figure 2b.
Figure 2b.. LA volume calculated using the method of discs (Simpson’s rule) in the apical 2-chamber view. The biplane measurement is calculated using the diameters from both views to calculate the volume of each disc and then summing the volumes together.
Figure 3a.
Figure 3a.. The pulse spectral Doppler appearance of LA appendage (LAA) flow during sinus rhythm (Reprinted with permission from Silverman DI and Manning WJ, The Complete Guide to Echocardiography. Jones & Bartlett Learning 2001; Sudbury MA)
Figure 3b.
Figure 3b.. LAA flow during atrial fibrillation. Flow velocities in this example are normal (>40 cm/sec).
Figure 3c.
Figure 3c.. LAA flow velocities are marked reduced in this example.
Figure 4a.
Figure 4a.. Transesophageal echocardiography (TEE), midesophageal view in a patient reveals an indistinct haziness (arrow) in the body of the LAA.
Figure 4b.
Figure 4b.. Injection of 2 cc of echo contrast (?Definity) solution completely opacifies the LAA , providing convincing evidence that there is no thrombus.The patient underwent successful conversion to sinus rhythm a few moments later without complication.
Figure 5.
Figure 5.. Atrial strain mapped using speckle tracking.
Figure 6.
Figure 6.. TEE midesophageal view demonstrates LAA thrombus (arrow).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Lang Roberto M, Bierig Michelle, Devereux Richard B, Flachskampf Frank A, Foster Elyse, Pellikka Patricia A, Picard Michael H, Roman Mary J, Seward James, Shanewise Jack S, Solomon Scott D, Spencer Kirk T, Sutton Martin St John, Stewart William J. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005 Dec;18 (12):1440–63. - PubMed
    1. Khankirawatana Banthit, Khankirawatana Suwanee, Porter Thomas. How should left atrial size be reported? Comparative assessment with use of multiple echocardiographic methods. Am. Heart J. 2004 Feb;147 (2):369–74. - PubMed
    1. Loperfido F, Pennestri F, Digaetano A, Scabbia E, Santarelli P, Mongiardo R, Schiavoni G, Coppola E, Manzoli U. Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease. Br Heart J. 1983 Dec;50 (6):570–8. - PMC - PubMed
    1. Kircher B, Abbott J A, Pau S, Gould R G, Himelman R B, Higgins C B, Lipton M J, Schiller N B. Left atrial volume determination by biplane two-dimensional echocardiography: validation by cine computed tomography. Am. Heart J. 1991 Mar;121 (3 Pt 1):864–71. - PubMed
    1. Barbieri Andrea, Bursi Francesca, Zanasi Vera, Veronesi Benedetta, Cioni Elena, Modena Maria Grazia. Left atrium reclassified: application of the American Society of Echocardiography/European Society of Cardiology cutoffs to unselected outpatients referred to the echocardiography laboratory. J Am Soc Echocardiogr. 2008 May;21 (5):433–8. - PubMed

LinkOut - more resources