Hemodynamic abnormalities in the left atrial appendage in patients with paroxysmal atrial fibrillation, with special reference to albumin-contrast echocardiographic aspects

Aim: We assessed the prolonged dysfunction of the left atrial appendage cau sed by paroxysmal atrial fibrillation. Methods and Results: Transesophageal echocardiography with intravenous albumin-microspheres (Albunex, 0.2 ml/kg ) was performed in 100 consecutive patients (44 patients in sinus rhythm wi thout previous paroxysmal atrial fibrillation: 13 patients in sinus rhythm who had had previous episodes of paroxysmal atrial fibrillation; and 43 pat ients with sustained atrial fibrillation). We compared the left atrial appe ndage ejection fraction and degree of opacification in the left atrial appe ndage with Albunex in the groups. Patients with previous paroxysmal atrial fibrillation had lower left atrial appendage ejection fractions than patien ts in sinus rhythm without paroxysmal atrial fibrillation (33 +/- 14 vs. 47 +/- 14%, p < 0.001). More than half of the patients (7/13 [54%]) with prev ious paroxysmal atrial fibrillation showed delayed and incomplete opacifica tion of the left atrial appendage with Albunex. Conclusion: We conclude tha t paroxysmal atrial fibrillation causes left atrial appendage stunning, at least in some patients.