Abstract TP231: Echocardiographically Identified Left Atrial Enlargement is Associated With Non-valvular Paroxysmal Atrial Fibrillation (PAF) and is a Surrogate for PAF Associated Risk for Embolic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Adeniyi O Molajo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Ecg Monitoring ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring

Introduction: Paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation are risk factors for systemic embolism including stroke. Both are indication for anticoagulation. Many patients with stroke in sinus rhythm are shown on ambulatory ECG monitoring to have PAF. PAF is difficult to diagnose on ambulatory ECG monitoring. A persistent marker for PAF will be useful to identify need for anticoagulant to reduce stroke risk due to PAF. Echocardiographic variable with a high predictive value for PAF is desirable. Objective: The purpose of the study was to investigate the relationship between left atrial (LA) size and proneness to paroxysmal atrial fibrillation and assess its reliability as a surrogate for diagnosing non valvular PAF. Method: Echo Database for patients with measured LA volume index, in sinus rhythm without history of intervention for atrial fibrillation, pharmacological therapy, and cardioversion or ablation therapy over a seven year period was reviewed. Patients with enlarged LA Volume index (>28ml/M 2 ) were selected. Seven Day ambulatory ECG monitoring was performed in these patients, ResultEchocardiogram data of 245 patients were available for analysis. 41 had greater than mild mitral valve regurgitation and were excluded from further analysis. Age range was 37-93. 99 were male. 211 patients had LA volume index data available. In 8 patients in sinus rhythm on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2) In 16 patients with PAF on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2 ) In 100 patients with PAF on ambulatory ECG, LA volume index was moderately increased (35-40 ml/M 2 ) In 88 patients with PAF on ambulatory ECG, LA volume index was severely increased (>40 ml/M 2 ) Conclusion: In patients with moderately and severely enlarged LA volume index, there was a high prevalence of paroxysmal atrial fibrillation on ambulatory ECG monitoring. Left Atrial volume index could serve as an echocardiographic surrogate for PAF and identify indication for anticoagulation to reduce stroke risk. It Is More Easily Identifiable Surrogate For PAF Than Ambulatory ECG Monitoring In Stroke Risk Assessment.

scholarly journals Clinical determinants of early spontaneous conversion to sinus rhythm in patients with atrial fibrillation

2021 ◽  
Author(s):  
N. A. H. A. Pluymaekers ◽  
E. A. M. P. Dudink ◽  
B. Weijs ◽  
K. Vernooy ◽  
D. E. J. Hartgerink ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Standard Of Care ◽  
Volume Index ◽  
Current Standard ◽  
Left Atrial Volume Index ◽  
First Onset ◽  
Spontaneous Conversion

Abstract Background The current standard of care for acute atrial fibrillation (AF) focuses primarily on immediate restoration of sinus rhythm by cardioversion, although AF often terminates spontaneously. Objective To identify determinants of early spontaneous conversion (SCV) in patients presenting at the emergency department (ED) because of AF. Methods An observational study was performed of patients who visited the ED with documented AF between July 2014 and December 2016. The clinical characteristics and demographics of patients with and without SCV were compared. Results We enrolled 943 patients (age 69 ± 12 years, 47% female). SCV occurred within 3 h of presentation in 158 patients (16.8%). Logistic regression analysis showed that duration of AF <24 h [odds ratio (OR) 7.7, 95% confidence interval (CI) 3.5–17.2, p < 0.001], left atrial volume index <42 ml/m2 (OR 1.8, 95% CI 1.2–2.8, p = 0.010), symptoms of near-collapse at presentation (OR 2.4, 95% CI 1.2–5.1, p = 0.018), a lower body mass index (BMI) (OR 0.9, 95% CI 0.91–0.99, p = 0.028), a longer QTc time during AF (OR 1.01, 95% CI 1.0–1.02, p = 0.002) and first-detected AF (OR 2.5, 95% CI 1.6–3.9, p < 0.001) were independent determinants of early SCV. Conclusion Early spontaneous conversion of acute AF occurs in almost one-sixth of admitted patients during a short initial observation in the ED. Spontaneous conversion is most likely to occur in patients with first-onset, short-duration AF episodes, lower BMI, and normal left atrial size.

scholarly journals Usefulness of Tissue Doppler-derived Atrial Electromechanical Delay for Identifying Patients with Paroxysmal Atrial Fibrillation

2020 ◽  
Author(s):  
Kanako Akamatsu ◽  
Takahide Ito ◽  
Masatoshi Miyamura ◽  
Yumiko Kanzaki ◽  
Koichi Sohmiya ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Tissue Doppler ◽  
Volume Index ◽  
Atrial Volume ◽  
Electromechanical Delay ◽  
Left Atrial Volume Index ◽  
Atrial Electromechanical Delay

Abstract Background: Tissue Doppler imaging (TDI)-derived atrial electromechanical delay (AEMD) has been reported to be useful for detecting paroxysmal atrial fibrillation (PAF). However, its usefulness remains unknown when analyzed along with patients seemingly at high-risk for AF as controls. From this standpoint, we investigated whether AEMD would be of use for identifying patients with PAF. Methods: We retrospectively analyzed TDI recordings to obtain AEMD in 63 PAF patients. Thirty-three patients with multiple cardiovascular risk factors (MRFs) but without history of AF and 50 healthy individuals served as disease and healthy controls, respectively. AEMD was defined as the time-interval between the electrocardiogram P-wave and the beginning of the spectral TDI-derived A’ for the septal (septal EMD) and lateral (lateral EMD) sides of the mitral annulus. Results: There was no significant difference in the left atrial volume index between PAF patients and disease controls (28 ± 9 mL/m 2 vs. 27 ± 5 mL/m 2 ). PAF patients had longer AEMD, particularly for the lateral EMD (75 ± 23 ms), compared with disease (62 ± 22 ms, P = 0.009) and healthy (54 ± 24 ms, P <0.001) controls. Multivariate logistic regression analysis revealed that the lateral EMD (OR 1.25, 95%CI 1.03 – 1.52, P = 0.023), along with the left atrial volume index (OR 2.25, 95%CI 1.44 – 3.51, P <0.001), was one of the significant independent associates of identifying PAF patients. Conclusions: This cross-sectional study indicates that even analyzed together with MRFs patients, AEMD remains useful for identifying patients at risk for AF. Our results need to be confirmed by a large-scale prospective study.

scholarly journals Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmet Demirkiran ◽  
Raquel P. Amier ◽  
Mark B. M. Hofman ◽  
Rob J. van der Geest ◽  
Lourens F. H. J. Robbers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Flow Velocity ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Peak Flow ◽  
Thrombus Formation ◽  
Clinical Value ◽  
4D Flow ◽  
Ssfp Cine

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

scholarly journals Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 554
Author(s):  
Stefan Naydenov ◽  
Nikolay Runev ◽  
Emil Manov
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Open Label ◽  
Before And After ◽  
Individualized Approach ◽  
Baseline Factors ◽  
And Function

Background and Objectives: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Materials and Methods: An open-label study aimed to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3 ± 7.4 years with paroxysmal/unknown duration of AF, considered for cardioversion, who agreed to have transesophageal echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p < 0.05 vs. baseline. Factors, associated most strongly with persistence of SEC/LAT, were left atrial appendage (LAA) emptying velocity <20 cm/s (OR = 2.82), LAA lobes >2 (OR = 1.84), and indexed left atrial volume ≥34 mL/m2 (OR = 1.37). Conclusions: In our study the incidence of SEC/LAT, particularly in AF with unknown duration, was not as low as we expected. The prevalence of SEC/LAT seemed to be dependent on factors not routinely evaluated in AF patients planned for cardioversion (indexed LA volume, LAA morphology and number of lobules, LAA emptying velocity, etc.). Our data suggested an individualized approach for DOAC duration in AF patients before an attempt for restoration of sinus rhythm is made, taking into consideration the LAA morphology and function.

Ambulatory ECG Monitoring in Atrial Fibrillation Management

2013 ◽  
Vol 56 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Spencer Z. Rosero ◽  
Valentina Kutyifa ◽  
Brian Olshansky ◽  
Wojciech Zareba
Keyword(s):  
Atrial Fibrillation ◽  
Ecg Monitoring ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring

scholarly journals Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement

2020 ◽  
Vol 47 (2) ◽  
pp. 78-85
Author(s):  
Kazuhiro Osawa ◽  
Rine Nakanishi ◽  
Indre Ceponiene ◽  
Negin Nezarat ◽  
William J. French ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Left Atrial Volume ◽  
Atrial Appendage ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Appendage Thrombus

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03–1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05–1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.

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