Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk
A Mugge,
H Kuhn,
P Nikutta,
J Grote,
JA Lopez,
and
WG Daniel
Division of Cardiology, Hannover Medical School, Germany.
OBJECTIVES. This study was conducted to identify a subgroup of patients with nonrheumatic atrial fibrillation with an increased risk for cardiogenic embolism by assessing left atrial appendage function. BACKGROUND. Patients with nonrheumatic atrial fibrillation have an increased risk for thromboembolic complications. The left atrial appendage is the most likely source for thrombus formation. It is likely that the appendage function (contraction, filling dynamics) is related to the pathogenesis of thrombus formation. METHODS. Twenty-nine patients with nonrheumatic atrial fibrillation (group I) underwent biplane transesophageal echocardiography. The maximal and minimal areas during a cardiac cycle and the peak emptying and filling velocities of the appendage were measured in both scan planes. For comparison, two additional groups were also analyzed. Group II consisted of 12 patients with chronic atrial fibrillation due to significant mitral stenosis, and group III consisted of 30 patients who were in sinus rhythm. RESULTS. Patients with nonrheumatic atrial fibrillation showed two distinct appendage flow patterns: either well defined peak filling and emptying waves (> or = 25 cm/s) with visible fibrillatory contractions of the appendage wall ("high flow profile") or irregular, very low, peak filling and emptying waves (< 25 cm/s) associated with almost no visible appendage contractions ("low flow profile"). The left atrial appendage function in the first subgroup resembles that seen in patients with sinus rhythm, whereas the appendage function in the latter subgroup resembles more the "static pouch" seen in patients with rheumatic atrial fibrillation. Events suggestive of cardiogenic embolism occurred in six patients from group I, five of whom were in the low flow profile subgroup (p < 0.05). The spontaneous echo contrast phenomenon was observed in 80% of the low flow profile subgroup but in only 5% in the high flow profile subgroup (p < 0.05). Three thrombi confined to the left atrial appendage were detected by transesophageal echocardiography in group I; all three of the patients were in the low flow profile subgroup. CONCLUSIONS. The assessment of left atrial appendage function by transesophageal echocardiography may be helpful to identify subgroups of patients with nonrheumatic atrial fibrillation with an increased risk of thrombus formation.
This article has been cited by other articles:
|
|
|
|
 
E. Doufekias, A. Z. Segal, and J. R. Kizer
Cardiogenic and aortogenic brain embolism.
J. Am. Coll. Cardiol.,
March 18, 2008;
51(11):
1049 - 1059.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bollmann, D. Husser, M. Stridh, F. Holmqvist, A. Roijer, C. J. Meurling, L. Sornmo, and S. B. Olsson
Atrial fibrillatory rate and risk of left atrial thrombus in atrial fibrillation
Europace,
August 1, 2007;
9(8):
621 - 626.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. M. Wazni, H.-M. Tsao, S.-A. Chen, H.-H. Chuang, W. Saliba, A. Natale, and A. L. Klein
Cardiovascular Imaging in the Management of Atrial Fibrillation
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
2077 - 2084.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. de Haan, M. Greiser, E. Harks, Y. Blaauw, A. van Hunnik, S. Verheule, M. Allessie, and U. Schotten
AVE0118, Blocker of the Transient Outward Current (Ito) and Ultrarapid Delayed Rectifier Current (IKur), Fully Restores Atrial Contractility After Cardioversion of Atrial Fibrillation in the Goat
Circulation,
September 19, 2006;
114(12):
1234 - 1242.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
651 - 745.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
854 - 906.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
e149 - e246.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
e257 - e354.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
700 - 752.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Eur. Heart J.,
August 2, 2006;
27(16):
1979 - 2030.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Donal, H. Yamada, C. Leclercq, and D. Herpin
The Left Atrial Appendage, a Small, Blind-Ended Structure: A Review of Its Echocardiographic Evaluation and Its Clinical Role
Chest,
September 1, 2005;
128(3):
1853 - 1862.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Erdogan, M. T. Goren, R. Diz-Kucukkaya, and M. Inanc
Assessment of Cardiac Structure and Left Atrial Appendage Functions in Primary Antiphospholipid Syndrome: A Transesophageal Echocardiographic Study
Stroke,
March 1, 2005;
36(3):
592 - 596.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Stollberger, B. Schneider, and J. Finsterer
Elimination of the Left Atrial Appendage To Prevent Stroke or Embolism?: Anatomic, Physiologic, and Pathophysiologic Considerations
Chest,
December 1, 2003;
124(6):
2356 - 2362.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. n. Garcia-Fernandez, E. Perez-David, J. Quiles, J. Peralta, I. Garcia-Rojas, J. Bermejo, M. Moreno, and J. Silva
Role of left atrial appendageobliteration in stroke reductionin patients with mitral valve prosthesis: A transesophageal echocardiographic study
J. Am. Coll. Cardiol.,
October 1, 2003;
42(7):
1253 - 1258.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N Fukuda, H Shinohara, K Sakabe, Y Onose, T Nada, and Y Tamura
Transthoracic Doppler echocardiographic measurement of left atrial appendage blood flow velocity: comparison with transoesophageal measurement
Eur J Echocardiogr,
September 1, 2003;
4(3):
191 - 195.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S Illien, S Maroto-Jarvinen, G von der Recke, C Hammerstingl, H Schmidt, S Kuntz-Hehner, B Luderitz, and H Omran
Atrial fibrillation: relation between clinical risk factors and transoesophageal echocardiographic risk factors for thromboembolism
Heart,
February 1, 2003;
89(2):
165 - 168.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Shimizu, Y. Murakami, S.-i. Inoue, Y. Ohta, K. Nakamura, H. Katoh, T. Sakne, N. Takahashi, S. Ohata, T. Sugamori, et al.
High Plasma Brain Natriuretic Polypeptide Level as a Marker of Risk for Thromboembolism in Patients With Nonvalvular Atrial Fibrillation
Stroke,
April 1, 2002;
33(4):
1005 - 1010.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Yamamura, Y. Miyoshi, S. Hiraki, H. Ono, H. Ootaki, J. Fujiyama, and M. Kuriyama
Spontaneous Echo Contrast in Descending Aorta Correlates with Low Blood-Flow Velocity in Carotid Arteries and Hemostatic Abnormalities
Angiology,
November 1, 2001;
52(11):
749 - 758.
[Abstract]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
Circulation,
October 23, 2001;
104(17):
2118 - 2150.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology
Eur. Heart J.,
October 2, 2001;
22(20):
1852 - 1923.
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
1231 - 1265.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
1266 - 1266.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Fukuchi, J. Watanabe, K. Kumagai, Y. Katori, S. Baba, K. Fukuda, T. Yagi, A. Iguchi, H. Yokoyama, M. Miura, et al.
Increased von Willebrand factor in the endocardium as a local predisposing factor for thrombogenesis in overloaded human atrial appendage
J. Am. Coll. Cardiol.,
April 1, 2001;
37(5):
1436 - 1442.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. L. Klein, R. D. Murray, and R. A. Grimm
Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation
J. Am. Coll. Cardiol.,
March 1, 2001;
37(3):
691 - 704.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bollmann, K.-H. Binias, F. Grothues, K. Sonne, H.-D. Esperer, P. Nikutta, and H. U. Klein
Left Atrial Appendage Flow in Nonrheumatic Atrial Fibrillation : Relationship With Pulmonary Venous Flow and ECG Fibrillatory Wave Amplitude
Chest,
February 1, 2001;
119(2):
485 - 492.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Roijer, J Eskilsson, and B Olsson
Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion
Eur. Heart J.,
May 2, 2000;
21(10):
837 - 847.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Y. Agmon, B. K. Khandheria, F. Gentile, and J. B. Seward
Echocardiographic assessment of the left atrial appendage
J. Am. Coll. Cardiol.,
December 1, 1999;
34(7):
1867 - 1877.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N M Al-Saady, O A Obel, and A J Camm
Left atrial appendage: structure, function, and role in thromboembolism
Heart,
November 1, 1999;
82(5):
547 - 554.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
P. B. Sparks, H. G. Mond, J. K. Vohra, A. G. Yapanis, L. E. Grigg, and J. M. Kalman
Mechanical Remodeling of the Left Atrium After Loss of Atrioventricular Synchrony : A Long-Term Study in Humans
Circulation,
October 19, 1999;
100(16):
1714 - 1721.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. G. Daoud, P. Marcovitz, B. P. Knight, R. Goyal, K. C. Man, S. A. Strickberger, W. F. Armstrong, and F. Morady
Short-Term Effect of Atrial Fibrillation on Atrial Contractile Function in Humans
Circulation,
June 15, 1999;
99(23):
3024 - 3027.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H Omran, W Jung, R Rabahieh, P Wirtz, H Becher, S Illien, R Schimpf, and B Lüderitz
Imaging of thrombi and assessment of left atrial appendage function: a prospective study comparing transthoracic and transoesophageal echocardiography
Heart,
February 1, 1999;
81(2):
192 - 198.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. K. Louie, D. Liu, S. I. Reynertson, H. S. Loeb, T. L. McKiernan, P. J. Scanlon, and R. J. Hariman
"Stunning" of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm: Demonstration by transesophageal Doppler techniques in a canine model
J. Am. Coll. Cardiol.,
December 1, 1998;
32(7):
2081 - 2086.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T.-M. Lee, N.-K. Chou, S.-F. Su, Y.-J. Lin, M.-F. Chen, C.-S. Liau, Y.-T. Lee, and S.-H. Chu
Left Atrial Spontaneous Echo Contrast in Asymptomatic Patients With a Mechanical Valve Prosthesis
Ann. Thorac. Surg.,
December 1, 1996;
62(6):
1790 - 1795.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. Rauh, M. Fischereder, and F. A. Spengel
Transesophageal Echocardiography in Patients With Focal Cerebral Ischemia of Unknown Cause
Stroke,
April 1, 1996;
27(4):
691 - 694.
[Abstract]
[Full Text]
|
|
|
|
