Hemodynamic Abnormalities in the Left Atrial Appendage in Patients with Paroxysmal Atrial Fibrillation, with Special Reference to Albumin-Contrast Echocardiographic Aspects

Abstract

Aim: We assessed the prolonged dysfunction of the left atrial appendage caused by paroxysmal atrial fibrillation. Methods and Results: Transesophageal echocardiography with intravenous albumin-microspheres (Albunex, 0.2 ml/kg) was performed in 100 consecutive patients (44 patients in sinus rhythm without previous paroxysmal atrial fibrillation: 13 patients in sinus rhythm who had had previous episodes of paroxysmal atrial fibrillation; and 43 patients with sustained atrial fibrillation). We compared the left atrial appendage ejection fraction and degree of opacification in the left atrial appendage with Albunex in the groups. Patients with previous paroxysmal atrial fibrillation had lower left atrial appendage ejection fractions than patients in sinus rhythm without paroxysmal atrial fibrillation (33 ± 14 vs. 47 ± 14%, p < 0.001). More than half of the patients (7/13 [54%]) with previous paroxysmal atrial fibrillation showed delayed and incomplete opacification of the left atrial appendage with Albunex. Conclusion: We conclude that paroxysmal atrial fibrillation causes left atrial appendage stunning, at least in some patients.