Analysis of electrical and mechanical left atrial properties in patients with persistent atrial fibrillation

Abstract

The study of left atrial (LA) mechanical function during atrial fibrillation (AFib) can provide valuable information, particularly if such profiling is related to the cavity electrical substrate and conveys prognostic information. To assess if there is any relation between LA mechanical and electrical asynchrony and if such evaluation can be of interest in stratifying AFib patients. 50 patients with persistent AFib who underwent electrical cardioversion (CV) were evaluated with pre-CV atrial electrograms (AEGs). Electrical asynchrony was classified according to Wells' patterns of AEGs, ranging from most organized (I) to most dispersed (III) one. LA mechanical asynchrony was addressed by transthoracic 2D-speckle-tracking echo and quantified according to time-to-peak standard deviation (TP-SD) of wall strains and their peak values (PS) before CV, after 24 h, at 1 month. Pre-CV a linear, inverse relation between TP-SD and PS (p < 0.001) and a direct linear relation between TP-SD and Wells' classes (p = 0.04) were observed. With sinus rhythm TP-SD decreased (p = 0.023) and PS increased (p < 0.001), suggesting improved LA mechanical milieu. A multivariate analysis, testing the effects of baseline variables in predicting post-CV recurrence of AFib, revealed that amount of TP-SD variation pre/24 h post-CV was the only independent predictor at 6 months (p = 0.046). Speckle tracking-derived LA parameters can describe LA wall forces during AFib, categorizing the asynchronous mechanistic profile of AFib that correlates with the degree of the dispersed LA electrical activity. The amount of changes in LA mechanical asynchrony pre/post-CV seems to have prognostic relevance in predicting SR maintenance.

Incremental value of left atrial mechanical dispersion over CHA2DS2‐VASc score in predicting risk of thrombus formation

“…24 In our study, we included more cases, and all of these cases had a clear diagnosis of LAAT (39 with LAAT vs 16 with sludge or LAAT). Furthermore, in contrast to other studies, 13,14 our analysis of LA synchronicity involved 2 apical chamber views and 12 segments for each patient.…”

“…Dispersed atrial mechanical activity is another interesting issue, especially in the context of documented interrelation between electrical asynchrony measured by atrial electrograms and mechanical asynchrony detected by 2DSTE . Most of the foregoing studies aimed to assess its significance in the predicting of sinus rhythm maintenance after direct current cardioversion or pulmonary veins isolation and to evaluate reverse remodeling after conversion into sinus rhythm . Asynchrony decreased in patients with AF after successful cardioversion and in patients with rheumatic mitral valve stenosis and sinus rhythm restoration after percutaneous treatment with balloon mitral valvuloplasty .…”

“…11,13 Asynchrony is another aspect of atrial mechanics. 13 Previous studies concerning asynchrony assessed it in electrical 14,15 or mechanical aspects 13,16,17 using intraoperative atrial wall mapping, 15 transesophageal recording of LA electrograms 14 or tissue Doppler imaging, 16 STE, 13,14 and three-dimensional echo. 17 Nevertheless, little is known about the meaning of intraatrial asynchrony and its possible associations with the formation of LAAT.…”

Left Atrial Dispersion Predicts Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy: A 5-year Follow-up study

“…In the study of Zhijuan Shang et al, atrial dispersion was found increased in PAF patients compared to the healthy group and atrial dispersion was found out to be an independent predictor of AF development in patients with a normal left atrium size 24 . In another study; a high atrial dispersion before cardioversion was found decreased after cardioversion in patients, who were planned to undergo cardioversion because of AF 25,26 . In the study by Kupczynska et al, atrial dispersion was found out to be an independent predictor of thrombus formation in the left atrial appendage (LAA) in patients, in whom transesophageal echocardiography (TEE) was performed because of AF 27 .…”

Right atrial function by speckle tracking echocardiography in atrial septal defect: Prediction of atrial fibrillation

“…In ASD patients the pathophysiological events related to PAF episodes were pre‐existent RA overload and device insertion, thus we studied RA dyssynchrony by determining the time‐to‐peak strain in the reservoir phase rather than during atrial contractile phase . RA pre‐closure strain, dyssynchrony, and volumetric parameters were significantly different compared to normal controls and associated with PAF.…”