NUMERIC VALUE OF LEFT ATRIAL APPENDAGE MEAN DIASTOLIC EMPTYING VELOCITY IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION, ASSESSED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR PREDICTION OF RESTORATION OF SINUS RHYTHM UNDERGOING DIRECT CURRENT CARDIOVERSION AND

Abstract

Objective: To determine the value of left atrial appendage mean diastolic emptying velocity at which there is restoration of normal sinus rhythm from atrial fibrillation either by electrical cardioversion or pharmacological cardioversion, development of clot in left atrial appendage or left atrium and long-term (at one month) sinus rhythm maintenance and to measure the value of left atrial appendage late diastolic emptying velocity after restoration of sinus rhythm at one month duration.

Study Design: Cross-sectional prospective study.

Place and Duration of Study: Department of Cardiac Electrophysiology, AFIC/NIHD Rawalpindi, from Oct 2020 to Apr 2021.

Methodology: Transthoracic echocardiography was used to gather standard echocardiographic data from individuals with atrial fibrillation, and trans esophageal echocardiography was used to determine mean diastolic emptying velocities in the left atrial appendage. All patients fulfilling inclusion criteria underwent direct current cardioversion and the late diastolic emptying velocity of left atrial appendage was measured after restoring sinus rhythm at one month of follow up by again performing trans-esophageal echocardiography. The diastolic emptying velocities of successful cardioverted patients and those still in atrial fibrillation (unsuccessful direct current cardioversion were compared and analyzed.

Results: Out of 61 patients, normal sinus rhythm was restored by successful cardioversion in 56 (91.8%) patients and all same (91.8%) patients had maintained normal sinus rhythm at 1 month interval checked on follow up. Patients who had their normal sinus rhythm restored by cardioversion had greater left atrial appendage mean diastolic emptying velocities, with a mean of 24.043.06 cm/s, than patients who had failed cardioversions, with a mean of 19.601. Out of 51cm/s (p=0.002). Patients who were remained in normal sinus rhythm at 1 month had lower left atrial volumes indexed to body surface area with a mean value of 27.023. Of 33 ml/m2 (p=0.001) and greater left atrial appendage late diastolic emptying velocities with a mean value of 45.394. Out of 70cm/s (p=0.001) compared to the patients who were still in atrial fibrillation.

Conclusion: As a marker of mechanical remodeling, left atrial appendage diastolic emptying velocity can anticipate successful cardioversion, short-term and long-term sinus rhythm maintenance after electrical cardioversion in AF patients and even presence of clot in left atrial appendage when having lower values.