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Predictors of left atrial appendage stunning after electrical cardioversion in patients with atrial fibrillation

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Abstract

The transient left atrial appendage (LAA) dysfunction after electrical cardioversion (CV), which is called as LAA-stunning, was found to be an important etiology of thrombus formation. The aim of the present study was to investigate the risk factors of LAA-stunning. This study included 134 patients who underwent catheter ablation for non-paroxysmal, non-valvular, and symptomatic atrial fibrillation (AF). Internal-CV was performed, and LAA emptying fraction (LAA-EF) was assessed using LAA-angiogram before and just after CV. LAA-stunning (defined as 10% reduction of LAA-EF after CV) was observed in 45/134 patients (34%). Patients in LAA-stunning group had longer duration of AF prior to CV, higher brain natriuretic peptide (BNP), higher prevalence of patients taking calcium blocker, larger left atrial (LA) diameter, elevated E wave, and larger LA volume than those in non LAA-stunning group. Multivariate analysis showed that longer duration of AF prior to CV (p = 0.015, OR 1.033 for 1 month extend, 95% CI 1.006–1.073) and elevated BNP (p = 0.038, OR 1.041 for each 10 pg/mL increase, 95% CI 1.001–1.009) were associated with LAA-stunning. In addition, all patients were divided into four groups based on the combination between duration of AF prior to CV and BNP; group 1 (low BNP/short-lasting AF), group 2 (high BNP/short-lasting AF), group 3 (low BNP/long-lasting AF), and group 4 (high BNP/long-lasting AF). The rate of LAA-stunning was the highest in the group 4 (55.6%). Elevated BNP and long duration of AF were associated with LAA stunning after electrical cardioversion.

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Authors and Affiliations

  1. Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan

    Hideyuki Kishima, Takanao Mine, Eiji Fukuhara, Kenki Ashida & Masaharu Ishihara

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  1. Hideyuki Kishima
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  2. Takanao Mine
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  3. Eiji Fukuhara
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  4. Kenki Ashida
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  5. Masaharu Ishihara
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Correspondence to Hideyuki Kishima.

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Kishima, H., Mine, T., Fukuhara, E. et al. Predictors of left atrial appendage stunning after electrical cardioversion in patients with atrial fibrillation. Int J Cardiovasc Imaging 35, 1549–1555 (2019). https://doi.org/10.1007/s10554-019-01592-y

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  • DOI: https://doi.org/10.1007/s10554-019-01592-y

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