The Influence of Electrical Cardioversion for Atrial Fibrillation on Left Atrial Appendage Function: A Transesophageal Echocardiography Study

Abstract Background Percutaneous left atrial appendage closure (LAAC) is being established as an alternative option for atrial fibrillation (AF) patients with high bleeding risk. Few studies reported the influence of percutaneous LAAC on left atrial (LA) performance, but most of the studies demonstrated no remarkable changes in their parameters after the procedure. Method The study included 95 patients (age: 75±6.7 years, 67% male) whom underwent percutaneous LAAC in a single center between September 2012 and November 2018. LA strain was evaluated at three different time intervals by transesophageal echocardiography (baseline, 45 days and 180 days after procedure). All data were analyzed using a dedicated. 70 patients had atrial fibrillation whereas 25 were in sinus rhythm. Analysis was performed for peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from segment of lateral wall in mid-esophageal 4 chamber view. The validity of lateral wall left atrial analysis was recently shown by our group. PACS was obtained in patients with sinus rhythm during exams. Results Compared to baseline, PALS was significantly increased after 45 days (12.4±8.4% vs 16.0±10.7%, p=0.001) and remained stable after 180 days (13.8±9.0% vs 17.0±12.4%, p=0.098). Even in only patients with atrial fibrillation during exams, it was increased (10.8±7.7% vs 13.4±7.1%, p=0.012 and 8.5±5.1% vs 13.9±8.1%, p=0.014). Similarly, compared with the baseline, PACS was significantly increased after 45 days and 180 days (5.8±3.9% vs 10.6±7.6%, p=0.001 and 4.5±2.6% vs 7.9±3.1%, p=0.036). The Changes in PALS and PACS Conclusion Our study has demonstrated for the first time the improvement in LA strain following LAAC within 45 days of implantation by transesophageal echocardiography and these values were maintained at least for 6 months. Further appraisal is warranted for confirmation of these preliminary findings.

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Analysis of real-time three dimensional transesophageal echocardiography in the assessment of left atrial appendage function in patients with atrial fibrillation

Experimental and Therapeutic Medicine ◽

10.3892/etm.2016.3745 ◽

2016 ◽

Vol 12 (5) ◽

pp. 3323-3327

Author(s):

Lin Gan ◽

Lan Yu ◽

Manying Xie ◽

Wei Feng ◽

Jiabao Yin

Keyword(s):

Atrial Fibrillation ◽

Transesophageal Echocardiography ◽

Real Time ◽

Left Atrial ◽

Left Atrial Appendage ◽

Three Dimensional ◽

Atrial Appendage

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Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter

Scientific Reports ◽

10.1038/s41598-019-54505-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Mei-Yao Wu ◽

Yen-Nien Lin ◽

Hung-Pin Wu ◽

Ying-Ying Huang ◽

Jan-Yow Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ejection Fraction ◽

Sinus Rhythm ◽

Transesophageal Echocardiography ◽

Atrial Flutter ◽

Left Atrial ◽

Left Atrial Appendage ◽

Inverse Correlation ◽

Atrial Appendage ◽

Inclusion Criteria

AbstractImpaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHA2DS2-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA2DS2-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.

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Transition from Transesophageal Echocardiography to Cardiac Computed Tomography for the Evaluation of Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation and Incidence of Cerebrovascular Events During the COVID-19 Pandemic

10.22541/au.162265870.05900100/v1 ◽

2021 ◽

Author(s):

Tauseef Akhtar ◽

Ryan Wallace ◽

Usama Daimee ◽

Erica Hart ◽

Armin Arbab-Zadeh ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Transesophageal Echocardiography ◽

Left Atrial ◽

Left Atrial Appendage ◽

Cardiac Computed Tomography ◽

Ct Imaging ◽

Atrial Appendage ◽

Af Ablation ◽

Cerebrovascular Events

Background Transesophageal echocardiography (TEE) is variably performed before atrial fibrillation (AF) ablation to evaluate left atrial appendage (LAA) thrombus. We describe our experience with transitioning to the pre-ablation cardiac computed tomography (CT) approach for the assessment of LAA thrombus during the COVID-19 pandemic. Methods We studied consecutive patients undergoing AF ablation at our center. The study cohort was divided into pre- vs. post-COVID groups. The pre-COVID cohort included ablations performed during 1 year before the COVID-19 pandemic; pre-ablation TEE was used routinely to evaluate LAA thrombus in high-risk patients. Post-COVID cohort included ablations performed during the 1 year after the COVID-19 pandemic; pre-ablation CT was performed in all patients, with TEE performed only in patients with LAA thrombus by CT imaging. The demographics, clinical history, imaging, and ablation characteristics, and peri-procedural cerebrovascular events (CVE) were recorded. Results A total of 637 patients (pre-COVID n=424, post-COVID n=213) were studied. The mean age was 65.6  10.1 years in the total cohort, and the majority were men. There was a significant increase in pre-ablation CT imaging from pre to post-COVID cohort (74.8 vs. 93.9%, p=<0.01), with a significant reduction in TEEs (34.6 vs. 3.7%, p=<0.01). One patient in the post-COVID cohort developed CVE following negative pre-ablation CT. However, the incidence of peri-procedural CVE between both cohorts remained statistically unchanged (0 vs. 0.4%, p=0.33). Conclusion Implementation of pre ablation CT-only imaging strategy with selective use of TEE for LAA thrombus evaluation is not associated with increased CVE risk during the COVID- 19 pandemic.

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