- 作者：Heyder Omran MD ; Werner Jung MD ; Rami Rabahieh MD ; Rainer Schimpf MD ; Christian Wolpert MD ; Andreas Hagendorff MD ; Wolfgang Fehske MD ; Berndt Lü ; deritz MD ; FACC
- 刊名：Journal of the American College of Cardiology
- 出版年：1997
- 出版时间：January 1997
- 年：1997
- 卷：29
- 期：1
- 页码：131-138
- 全文大小：764 K
Background. External cardioversion of atrial fibrillation may result in left atrial appendage dysfunction (“stunning”) and may promote thrombus formation. In contrast to external cardioversion, internal atrial defibrillation utilizes lower energies; however, it is unknown whether the use of lower energies may avoid stunning of the left atrial appendage.
Methods. Transesophageal and transthoracic echocardiography were performed in 20 patients 24 h before and 1 and 7 days after internal atrial defibrillation to assess both left atrial chamber and appendage function. Transthoracic echocardiography was again performed 28 days after internal atrial defibrillation to assess left atrial function. The incidence and degree of spontaneous echo contrast accumulation (range 1+ to 4+) was noted, and peak emptying velocities of the left atrial appendage were measured before and after internal atrial defibrillation. To determine left atrial mechanical function, peak A wave velocities were obtained from transmitral flow velocity profiles.
Results. Sinus rhythm was restored in all patients. The mean ± SD peak A wave velocities increased gradually after cardioversion, from 0.47 ± 0.16 m/s at 24 h to 0.61 ± 0.13 m/s after 7 days (p < 0.05) and 0.63 ± 0.13 m/s after 4 weeks. Peak emptying velocities of the left atrial appendage were 0.37 ± 0.16 m/s before internal atrial defibrillation, decreased significantly after internal atrial defibrillation to 0.23 ± 0.1 m/s at 24 h (p < 0.01) and then recovered to 0.49 ± 0.23 m/s (p < 0.01) after 7 days. The corresponding values for the degree of spontaneous echo contrast were 1.2 ± 1.2 before internal atrial defibrillation versus 2.0 ± 1.0 (p < 0.01) and 1.1 ± 1.3 (p < 0.01) 1 and 7 days after cardioversion, respectively. One patient developed a new thrombus in the left atrial appendage, and another had a thromboembolic event after internal atrial defibrillation.
Conclusions. Internal atrial defibrillation causes depressed left atrial chamber and appendage function and may result in the subacute accumulation of spontaneous echo contrast and development of new thrombi after cardioversion. These findings have important clinical implications for anticoagulation therapy before and after low energy internal atrial defibrillation in patients with atrial fibrillation.
(J Am Coll Cardiol 1997;29:131–8)>