RT-139
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Atrial contractility recovery
after transthoracic cardioversion (TC) of atrial fibrillation: possible role of permanent
atrial pacing
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Pietro Broglia, Maddalena
Lettino, Stefano Perlini, Marco Ferrario, Andrea Finzi, Salvatore Romano.
Division of Cardiology, Maggiore Hospital IRCCS, Milan, Italy
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Abstract
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Background. The absence of atrial
contractile function following sinus rhythm restoration after electrical cardioversion
(CV) of atrial fibrillation (AF) increases the risk of thromboembolic complications.
Several studies investigated the possible determinants of atrial mechanical dysfunction
suggesting a role for mode of cardioversion and myocardial depressant effects of
antiarrhythmic drugs.
Objectives. We sought to evaluate the possible role of heart rate
soon after sinus rhythm restoration by electrical CV on recovery of atrial function.
Methods. 18 patients (pts) underwent successful CV for AF. Six were
PM patients (mean age 78.6, 5 males, programmed pacing rate of 80) and 12 were non-PM pts
(mean age 60.5, 8 males).
Serial transmitral inflow Doppler velocities were recorded before and soon after (<
60 minutes) sinus rhythm restoration and subsequently at 12 hours day 3 and day 7, to
identify a distinct atrial filling (A) wave (peak velocity > 0.3 m/sec) as a marker of
atrial contraction.
Results. Effective atrial mechanical function recovered in 66.6% of
PM pts and in 58.3% of non-PM pts, within 12 hours; moreover in non-PM pts with a
detectable early atrial filling (A) wave heart rate was statistically significant higher
than in non-PM pts with a lack of left atrial mechanical function by day 7.
Conclusions. These preliminary data seem to indicate that a higher
heart rate soon after electrical CV may be associated with an earlier recovery of
effective atrial mechanical function, and consequently with a possible reduction of the
risk of thromboembolic complications after a successful electrical cardioversion.
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Key Words
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Atrial fibrillation - transthoracic electrical
cardioversion
atrial contractile function, risk of thromboembolism, atrial stunning, heart rate, role of
permanent atrial pacing, OA
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