Atrial Electromechanical Delay Measured by Tissue Doppler Imaging in Patients with Secundum Atrial Septal Defects

Abstract

SEE ARTICLES ON PAGES 699 AND 706Atrial septal defects (ASDs) cause left-to-right shunt because the pressure in the left atrium is usually higher than the right atrial pressure. Left-to-right shunting across the ASD produces dilatation and hypertrophy of the right atrium and right ventricle. The resulting increased pulmonary venous return causes left atrial dilatation. Enlarged atria may increase conduction time of the impulse originating in the sinus node as well as result in nonhomogeneous spread of the electrical impulse. These abnormalities may in part be responsible for tachyarrhythmias seen in patients with ASD. Atrial electromechanical delay (AEMD) may characterize these abnormalities and has been measured in the past during invasive electrophysiologic studies. 1 Tissue Doppler imaging (TDI) uses Doppler echocardiography to image the motion of the tissue. Doppler echocardiography measures blood flow velocity while TDI measures myocardial tissue velocity, which has higher amplitude but lower velocity signals. 2 Primary measurements include the systolic (S), early diastolic (Ea or E′), and late diastolic (Aa or A′) velocities. The AEMD mentioned in the preceding paragraph can also be measured noninvasively using TDI. The time interval between the onset of Pwave on the electrocardiogram to the A-wave of the simultaneously recorded TDI may be termed PA interval and can be recorded from lateral and septal mitral annuli and lateral tricuspid (right ventricle) annulus locations and right intra-AEMD, left intra-AEMD and inter-AEMD may be calculated. 3-5 There appears to be interest in assessing the atrial function using AEMD in patients with different disease states including mitral stenosis, familial Mediterranean fever, rheumatoid arthritis, atrial septal aneurysms, atrial fibrillation, scleroderma, ankylosing spondylitis, and type 1 diabetes. [3][4][5] There is limited experience in use of this technique in patients with ASDs.In a recent publication 6 as well as in the current issue of the Journal, 7 AEMD in patients with atrial septal defects has been investigated. Erturk et al. 6 evaluated AEMD and left atrial mechanical function in 72 patients with secundum ASD and compared them with those of 35 gender and age-matched control subjects. They found that left atrial active and total emptying fractions and conduit volumes were lower and total emptying volume was higher in the patients with ASD compared to the control group while passive emptying volume and fraction and active emptying volumes were not different significantly between the groups. The left intra-atrial, right intra-atrial and inter-atrial EMDs were also significantly longer in the ASD group. The authors conclude that left atrial reservoir and contractile pump functions are decreased and the left intraatrial, right intra-atrial and inter-atrial electromechanical delays are increased in the patients with ASD. Oflaz et al. 7 also evaluated AEMD in 35 patients with secundum ASDs and compared them with those of 22 age-matched control subjects. They foun...

Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay

“…Atrial electromechanical delay duration is the sum of impulse propagation from sinus node to the atria and atrial electromechanical coupling duration. It has been studied in some clinical conditions . Deniz et al., in a study comparing tissue Doppler echocardiography and electrophysiological study, found a moderate correlation between ILCT‐echo and ILCT‐eps, and demonstrated that tissue Doppler echocardiography can be used for the measurement of interatrial and intra‐left atrial conduction times.…”

Impact of Continuous Positive Airway Pressure Therapy on Atrial Electromechanical Delay in Obesity‐Hypoventilation Syndrome Patients

“…Previous studies have demonstrated that prolonged intra-and inter-atrial conduction times and inhomogeneous propagation of sinus impulses would be the characteristics of increased AF risk in various clinical conditions during sinus rhythm. 27 It has been studied in some clinical conditions, [28][29][30][31] and it was found that AEMD is significantly correlated with the prolonged maximum P-wave duration, P-wave dispersion, and degree of histopathological changes. [32][33][34] Previous studies evaluated the predictive role of intra-left atrial electromechanical delay for paroxysmal atrial fibrillation recurrence after cardioversion, [35][36][37] lone atrial fibrillation attack, 38 new-onset AF after acute myocardial infarction, 39 occurrence of atrial arrhythmias in adult patients with congenital heart diseases, 40 myotonic dystrophy type 1, 41 and atrial septal aneurysm.…”

The Author’s Contributions to Echocardiography Literature (Part II—1991–2020)

“…A number of editorials addressing echo-Doppler related subjects were contributed by the author [17][18][19][20][21]; most of these are prepared at the request of the respective chief editors. These Based on these data, it was concluded that the long-term results of BPV are excellent and that BPV is the management of option in the treatment of valvar PS; however, our study raises concern regarding development of PI at long-term follow-up [16].…”

“…A number of editorials addressing echo-Doppler related subjects were contributed by the author [17][18][19][20][21]; most of these are prepared at the request of the respective chief editors. These…”

“…A number of editorials addressing echo-Doppler related subjects were contributed by the author [17][18][19][20][21]; most of these are prepared at the request of the respective chief editors. These editorials addressed cardiac function in juvenile rheumatoid arthritis [17], heart function following transcatheter occlusion of patent foramen ovale [18], LV function after percutaneous occlusion of ASDs [19], atrial electromechanical delay assessed by tissue Doppler imaging in subjects with secundum ASDs [20], of 30 and whether intracardiac echocardiography is necessary for monitoring implantation of stents across the site of coarctation of the aorta [21].…”