Left atrial dysfunction in patients with atrial fibrillation after successful rhythm control for > 3 months

Yi Chih Wang, Jiunn Lee Lin, Juey Jen Hwang, Mao Shin Lin, Chuen Den Tseng, Shoei K.Stephen Huang, Ling Ping Lai

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Large-scale clinical trials have demonstrated that patients with atrial fibrillation (AF), when treated with a rhythm-control strategy, are still at risk for embolic events. We hypothesized that left atrial (LA) dysfunction persisted even after successful maintenance of sinus rhythm for > 3 months. Methods: A total of 93 patients with AF and satisfactory rhythm control for > 3 months were included. Satisfactory rhythm control was defined as being free of AF based on patient-reported symptoms, monthly ECG follow-up, and ambulatory Holter ECG if needed. Among the 93 patients, 25 patients had sustained AF that was terminated by electrical or pharmacologic cardioversion, while 68 patients had paroxysmal AF under good medical control. Clinical data were obtained, and transthoracic and transesophageal echocardiography were performed after satisfactory rhythm control for > 3 months. Results: Among the 93 patients, 34 patients (37%) had LA dysfunction, defined as LA appendage (LAA) peak emptying velocity < 40 cm/s or spontaneous echo contrast and/or thrombus in the LA or LAA. When compared to the other 59 patients without LA dysfunction, they had larger LA dimension (40 ± 6 mm vs 36 ± 8 mm [± SD], p = 0.018) but did not differ significantly regarding the left ventricular (LV) chamber size, LV ejection fraction, mitral or tricuspid inflow, and ratio of the amplitude of the waves created by early diastolic filling and atrial contraction. We also analyzed the relationship between LA function and clinical risk factors for stroke, including hypertension, diabetes mellitus, coronary artery disease, age > 65 years, and prior cerebral vascular accident LA dysfunction was found in 10 of 17 patients (59%) with three or more risk factors. The odds ratio for having LA dysfunction was 3.1 (p = 0.04; 95% confidence interval, 1.1 to 9.1) when compared with patients with less than three risk factors. Conclusions: LA dysfunction was present in more than one third of AF patients after satisfactory rhythm control for > 3 months. Patients with higher burden (three or more) of clinical risk factors were more likely to have impaired LA function.

Original languageEnglish
Pages (from-to)2551-2556
Number of pages6
JournalChest
Volume128
Issue number4
DOIs
Publication statusPublished - Jan 1 2005
Externally publishedYes

Fingerprint

Atrial Fibrillation
Electrocardiography
Left Atrial Function
Atrial Appendage
Electric Countershock
Transesophageal Echocardiography
Accidents
Blood Vessels
Echocardiography
Odds Ratio
Maintenance
Clinical Trials
Confidence Intervals

Keywords

  • Atrial fibrillation
  • Embolization
  • Left atrium
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Wang, Y. C., Lin, J. L., Hwang, J. J., Lin, M. S., Tseng, C. D., Huang, S. K. S., & Lai, L. P. (2005). Left atrial dysfunction in patients with atrial fibrillation after successful rhythm control for > 3 months. Chest, 128(4), 2551-2556. https://doi.org/10.1378/chest.128.4.2551

Left atrial dysfunction in patients with atrial fibrillation after successful rhythm control for > 3 months. / Wang, Yi Chih; Lin, Jiunn Lee; Hwang, Juey Jen; Lin, Mao Shin; Tseng, Chuen Den; Huang, Shoei K.Stephen; Lai, Ling Ping.

In: Chest, Vol. 128, No. 4, 01.01.2005, p. 2551-2556.

Research output: Contribution to journalArticle

Wang, Yi Chih ; Lin, Jiunn Lee ; Hwang, Juey Jen ; Lin, Mao Shin ; Tseng, Chuen Den ; Huang, Shoei K.Stephen ; Lai, Ling Ping. / Left atrial dysfunction in patients with atrial fibrillation after successful rhythm control for > 3 months. In: Chest. 2005 ; Vol. 128, No. 4. pp. 2551-2556.
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abstract = "Background: Large-scale clinical trials have demonstrated that patients with atrial fibrillation (AF), when treated with a rhythm-control strategy, are still at risk for embolic events. We hypothesized that left atrial (LA) dysfunction persisted even after successful maintenance of sinus rhythm for > 3 months. Methods: A total of 93 patients with AF and satisfactory rhythm control for > 3 months were included. Satisfactory rhythm control was defined as being free of AF based on patient-reported symptoms, monthly ECG follow-up, and ambulatory Holter ECG if needed. Among the 93 patients, 25 patients had sustained AF that was terminated by electrical or pharmacologic cardioversion, while 68 patients had paroxysmal AF under good medical control. Clinical data were obtained, and transthoracic and transesophageal echocardiography were performed after satisfactory rhythm control for > 3 months. Results: Among the 93 patients, 34 patients (37{\%}) had LA dysfunction, defined as LA appendage (LAA) peak emptying velocity < 40 cm/s or spontaneous echo contrast and/or thrombus in the LA or LAA. When compared to the other 59 patients without LA dysfunction, they had larger LA dimension (40 ± 6 mm vs 36 ± 8 mm [± SD], p = 0.018) but did not differ significantly regarding the left ventricular (LV) chamber size, LV ejection fraction, mitral or tricuspid inflow, and ratio of the amplitude of the waves created by early diastolic filling and atrial contraction. We also analyzed the relationship between LA function and clinical risk factors for stroke, including hypertension, diabetes mellitus, coronary artery disease, age > 65 years, and prior cerebral vascular accident LA dysfunction was found in 10 of 17 patients (59{\%}) with three or more risk factors. The odds ratio for having LA dysfunction was 3.1 (p = 0.04; 95{\%} confidence interval, 1.1 to 9.1) when compared with patients with less than three risk factors. Conclusions: LA dysfunction was present in more than one third of AF patients after satisfactory rhythm control for > 3 months. Patients with higher burden (three or more) of clinical risk factors were more likely to have impaired LA function.",
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AU - Wang, Yi Chih

AU - Lin, Jiunn Lee

AU - Hwang, Juey Jen

AU - Lin, Mao Shin

AU - Tseng, Chuen Den

AU - Huang, Shoei K.Stephen

AU - Lai, Ling Ping

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N2 - Background: Large-scale clinical trials have demonstrated that patients with atrial fibrillation (AF), when treated with a rhythm-control strategy, are still at risk for embolic events. We hypothesized that left atrial (LA) dysfunction persisted even after successful maintenance of sinus rhythm for > 3 months. Methods: A total of 93 patients with AF and satisfactory rhythm control for > 3 months were included. Satisfactory rhythm control was defined as being free of AF based on patient-reported symptoms, monthly ECG follow-up, and ambulatory Holter ECG if needed. Among the 93 patients, 25 patients had sustained AF that was terminated by electrical or pharmacologic cardioversion, while 68 patients had paroxysmal AF under good medical control. Clinical data were obtained, and transthoracic and transesophageal echocardiography were performed after satisfactory rhythm control for > 3 months. Results: Among the 93 patients, 34 patients (37%) had LA dysfunction, defined as LA appendage (LAA) peak emptying velocity < 40 cm/s or spontaneous echo contrast and/or thrombus in the LA or LAA. When compared to the other 59 patients without LA dysfunction, they had larger LA dimension (40 ± 6 mm vs 36 ± 8 mm [± SD], p = 0.018) but did not differ significantly regarding the left ventricular (LV) chamber size, LV ejection fraction, mitral or tricuspid inflow, and ratio of the amplitude of the waves created by early diastolic filling and atrial contraction. We also analyzed the relationship between LA function and clinical risk factors for stroke, including hypertension, diabetes mellitus, coronary artery disease, age > 65 years, and prior cerebral vascular accident LA dysfunction was found in 10 of 17 patients (59%) with three or more risk factors. The odds ratio for having LA dysfunction was 3.1 (p = 0.04; 95% confidence interval, 1.1 to 9.1) when compared with patients with less than three risk factors. Conclusions: LA dysfunction was present in more than one third of AF patients after satisfactory rhythm control for > 3 months. Patients with higher burden (three or more) of clinical risk factors were more likely to have impaired LA function.

AB - Background: Large-scale clinical trials have demonstrated that patients with atrial fibrillation (AF), when treated with a rhythm-control strategy, are still at risk for embolic events. We hypothesized that left atrial (LA) dysfunction persisted even after successful maintenance of sinus rhythm for > 3 months. Methods: A total of 93 patients with AF and satisfactory rhythm control for > 3 months were included. Satisfactory rhythm control was defined as being free of AF based on patient-reported symptoms, monthly ECG follow-up, and ambulatory Holter ECG if needed. Among the 93 patients, 25 patients had sustained AF that was terminated by electrical or pharmacologic cardioversion, while 68 patients had paroxysmal AF under good medical control. Clinical data were obtained, and transthoracic and transesophageal echocardiography were performed after satisfactory rhythm control for > 3 months. Results: Among the 93 patients, 34 patients (37%) had LA dysfunction, defined as LA appendage (LAA) peak emptying velocity < 40 cm/s or spontaneous echo contrast and/or thrombus in the LA or LAA. When compared to the other 59 patients without LA dysfunction, they had larger LA dimension (40 ± 6 mm vs 36 ± 8 mm [± SD], p = 0.018) but did not differ significantly regarding the left ventricular (LV) chamber size, LV ejection fraction, mitral or tricuspid inflow, and ratio of the amplitude of the waves created by early diastolic filling and atrial contraction. We also analyzed the relationship between LA function and clinical risk factors for stroke, including hypertension, diabetes mellitus, coronary artery disease, age > 65 years, and prior cerebral vascular accident LA dysfunction was found in 10 of 17 patients (59%) with three or more risk factors. The odds ratio for having LA dysfunction was 3.1 (p = 0.04; 95% confidence interval, 1.1 to 9.1) when compared with patients with less than three risk factors. Conclusions: LA dysfunction was present in more than one third of AF patients after satisfactory rhythm control for > 3 months. Patients with higher burden (three or more) of clinical risk factors were more likely to have impaired LA function.

KW - Atrial fibrillation

KW - Embolization

KW - Left atrium

KW - Transesophageal echocardiography

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