Severe Left Atrial Appendage Stunning After Electrical Cardioversion of Atrial Fibrillation

Abstract

HomeCirculationVol. 118, No. 21Severe Left Atrial Appendage Stunning After Electrical Cardioversion of Atrial Fibrillation Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBSevere Left Atrial Appendage Stunning After Electrical Cardioversion of Atrial Fibrillation Rowlens M. Melduni, MD, Naser M. Ammash, MD, Mark J. Callahan, MD, Joseph F. Malouf, MD, Krishnaswamy Chandrasekaran, MD and Bernard J. Gersh, MBChB, DPhil Rowlens M. MelduniRowlens M. Melduni From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Search for more papers by this author , Naser M. AmmashNaser M. Ammash From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Search for more papers by this author , Mark J. CallahanMark J. Callahan From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Search for more papers by this author , Joseph F. MaloufJoseph F. Malouf From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Search for more papers by this author , Krishnaswamy ChandrasekaranKrishnaswamy Chandrasekaran From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Search for more papers by this author and Bernard J. GershBernard J. Gersh From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Search for more papers by this author Originally published18 Nov 2008https://doi.org/10.1161/CIRCULATIONAHA.108.787374Circulation. 2008;118:e699–e700A 77-year-old man with a history of ischemic cardiomyopathy presented with 3 days of progressively worsening dyspnea. An ECG revealed atrial fibrillation at a rate of 97 bpm. An echocardiogram showed severe left atrial enlargement, severely elevated left ventricular filling pressure, and an ejection fraction of 30%. Thyroid function studies were normal. His symptoms of dyspnea improved modestly with intravenous diuresis. A transesophageal-guided cardioversion was performed to restore atrial systole. The patient was concurrently enrolled in a research study designed to assess left atrial appendage (LAA) stunning after electric cardioversion of atrial fibrillation. After electrical cardioversion, LAA velocities were markedly reduced, and a de novo 1.14×1.17-cm mobile thrombus was detected in the LAA consistent with severe LAA stunning (Figure and online-only Data Supplement movies). The phenomenon of atrial stunning is thought to occur in most patients after cardioversion of atrial fibrillation,1,2 underscoring the importance of anticoagulation in the immediate postcardioversion period to reduce the risk of thromboembolic events.3Download figureDownload PowerPointFigure. Doppler flow velocity profiles in left atrial appendage (upper panels) and 2-dimensional images of the LAA before (A and B) and immediately after (C and D) direct-current cardioversion of patient with atrial fibrillation, illustrating severe atrial stunning. Note the marked reduction in late (post-A wave) LAA diastolic emptying velocity (C) and the newly formed LAA thrombus (D) after restoration of in sinus rhythm.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/118/21/e699/DC1.AcknowledgmentWe acknowledge Mark Zangs for his expert technical assistance.DisclosuresNone.FootnotesReprint requests to Rowlens M. Melduni, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail [email protected]References1 Melduni RM, Malouf JF, Chandrasekaran K, Bruce CJ, White RD, Law KK, Al Atawi FO, Somers VK, Gersh BJ, Hodge DO, Friedman PA, Seward JB, Ammash NM. New insights into the predictors of left atrial stunning after successful direct-current cardioversion of atrial fibrillation and flutter. J Am Soc Echocardiogr. 2008; 21: 848–854.CrossrefMedlineGoogle Scholar2 Fatkin D, Kuchar DL, Thornburn CW, Feneley MP. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for “atrial stunning” as a mechanism of thromboembolic complications. J Am Coll Cardiol. 1994; 23: 307–316.CrossrefMedlineGoogle Scholar3 Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994; 154: 1449–1457.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails November 18, 2008Vol 118, Issue 21 Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.787374PMID: 19015407 Originally publishedNovember 18, 2008 PDF download Advertisement SubjectsAnticoagulantsArrhythmiasCerebrovascular Disease/StrokeContractile FunctionEchocardiographyEpidemiology