ATRIAL MECHANICAL FUNCTION BEFORE AND AFTER ELECTRICAL OR AMIODARONE CARDIOVERSION IN ATRIAL-FIBRILLATION - ASSESSMENT BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND PULSED DOPPLER

In some patients with atrial fibrillation (AF) it has been suggested t hat left atrial mechanical dysfunction can develop after successful el ectrical cardioversion, justifying postcardioversion anticoagulant tre atment. The purpose of this study teas to investigate differences in l eft atrial appendage peak flow velocities and the incidence of left at rial spontaneous echo contrast in patients with AF before and after el ectrical cardioversion or intravenous amiodarone, studied using transe sophageal echocardiography (TEE) and pulsed Doppler. We performed a co ntrol TEE in 7 patients in the electrical group and 6 in the amiodaron e group, with no significant clinical differences between both groups. A second TEE was performed immediately in the 7 patients with success ful electrical cardioversion. The peak flow velocities in the appendag e before and after the procedure were: filling 43.3 +/- 22 vs 27.7 +/- 28 cm/sec (P = 0.01) and emptying 35.5 +/- 22 vs 23.6 +/- 17 cm/sec ( P = 0.01), respectively. The spontaneous echo contrast increased in 4 of the 7 patients. In 4 patients of the amiodarone group, the peak flo w velocities in the appendage during AF and within the first 24 hours after restoration of sinus rhythm were: filling 37.4 +/- 12 vs 37.8 +/ - 18 cm/sec and emptying 36.4 +/- 18 vs 35.9 +/- 18 cm/sec, respective ly (P = NS). There was no change in spontaneous echo contrast. In conc lusion, patients with AF reverted to sinus rhythm using amiodarone did not show changes in left atrial mechanical function; however patients with electrical cardioversion showed mechanical dysfunction. Further investigations on the effects of amiodarone and other drugs on the mec hanical function of the atria are needed to determine if patients reve rted pharmacologically require anticoagulation post reversion.