ACUTE CHANGES IN SPONTANEOUS ECHO CONTRAST AND ATRIAL FUNCTION AFTER CARDIOVERSION OF PERSISTENT ATRIAL-FLUTTER

With use of transesophageal echocardiography, the short-term effects o f transthoracic electrical cardioversion of atrial flutter (AFI) on at rial mechanical function and spontaneous echo contrast were determined . Thirty patients who had AFI for a mean of 6.4 +/- 12.2 months underw ent transthoracic cardioversion, A transesophageal echocardiogram was recorded immediately before cardioversion, and left atrial appendage e mptying velocity and spontaneous contrast were assessed serially at 1, 3, and 5 minutes after cardioversion in 28 patients, and also at 8, 1 0, and 15 minutes after cardioversion in a subgroup of 13 patients. Ca rdioversion was deferred in 2 patients (7%) because a thrombus was fou nd in the left atrial appendage. Before cardioversion, spontaneous con trast was present in the left atrium in 7 of 28 patients (25%) who und erwent cardioversion. The mean left atrial appendage emptying velocity of 54 +/- 22 cm/s before cardioversion fell by 26% to 40 +/- 25 cm/s at 1 minute after restoration of sinus rhythm (p <0.01). There were no significant changes in the mean left atrial appendage-emptying veloci ty between 1 and 15 minutes after cardioversion. Within 5 minutes afte r conversion to sinus rhythm, left atrial spontaneous echo contrast de veloped de novo or worsened in 12 of the 28 patients (43%). In conclus ion, the results of this study demonstrate that persistent AFI may be associated with left atrial thrombi before cardioversion and that card ioversion of AFI is associated with a significant degree of atrial stu nning and formation of spontaneous echo contrast. (C)1998 by Excerpta Medica, Inc.