IS LEFT ATRIAL APPENDAGE FLOW A PREDICTOR FOR OUTCOME OF CARDIOVERSION OF NONVALVULAR ATRIAL-FIBRILLATION - A TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

Accurate echocardiographic parameters for predicting the success of ca rdioversion or maintenance of sinus rhythm are poorly defined. This pr ospective transthoracic and transesophageal echocardiographic study wa s conducted to test the hypothesis that the left atrial appendage flow pattern could be a predictive parameter of the success of cardioversi on and maintenance of sinus rhythm in patients with nonvalvular atrial fibrillation. Eighty-two consecutive patients with nonvalvular atrial fibrillation of less than or equal to 6 months' duration underwent tr ansesophageal examination after transthoracic echocardiography. After exclusion of left atrial thrombus, pharmacologic (n = 18) or electrica l (n = 64) cardioversion was successful in 75 of 82 patients. In the g roup that underwent successful cardioversion, maintenance of sinus rhy thm (n = 35) or recurrence of arrhythmia (n = 40) was assessed during a 1-year follow-up. During transesophageal examination, five left atri al appendage thrombi were found, spontaneous echo contrast was present in 26 (32%) patients; and mean peak left atrial appendage emptying ve locity was 35 +/- 18 cm/sec. Peak left atrial appendage emptying veloc ity was found to be statistically related to parameters of left ventri cular and left atrial function but not to long-term maintenance of sin us rhythm. No other echocardiographic parameter was identified as a pr edictor for either the success of cardioversion or the maintenance of sinus rhythm at follow-up. In patients with nonvolvular atrial fibrill ation of recent onset, peak left atrial appendage emptying velocity ap pears to be a complex parameter depending on left atrial and left vent ricular function but that does not predict either the success rate of cardioversion or long-term maintenance of sinus rhythm after successfu l cardioversion.