Effects of Ventricular Rate and Regularity on the Velocity and Magnitude of Left Atrial Appendage Flow in Atrial Fibrillation

Overview

Journal Heart

Date 2005 May 17

PMID 15894771

Citations 3

Authors

O A Obel

L Luddington

N Maarouf

K Aytemir

C Ekwall

M Malik

A J Camm

Affiliations

Soon will be listed here.

Abstract

Objective: To prospectively determine whether ventricular rate and regularity are significant determinants of the velocity and magnitude of left atrial appendage (LAA) flow.

Design And Patients: 12 patients with atrial fibrillation (AF), high degree atrioventricular block, and indwelling permanent pacemakers were studied.

Setting: Cardiology department of a tertiary referral centre.

Interventions: Pacing was triggered by an external programmable transcutaneous device. Patients were paced at 60, 120, and 150 beats/min in both regular and irregular rhythm. LAA flow velocity and magnitude were assessed with transoesophageal Doppler echocardiography.

Main Outcome Measures: Peak and mean LAA inflow and outflow velocity, and time-velocity interval (TVI) of LAA flow.

Results: Increasing ventricular rate was associated with significantly lower peak inflow (p < 0.01), peak outflow (p < 0.05), mean inflow (p < 0.01), and mean outflow (p < 0.05) velocities and with a lower TVI of LAA filling and emptying velocities (p < 0.01). This effect was noted at rates of 60 beats/min compared with both 120 and 150 beats/min. At a pacing rate of 120 beats/min there was a significantly higher total TVI when pacing at a regular than at an irregular rhythm (40.16 (14.6) cm v 30.74 (10.9) cm, p < 0.05).

Conclusions: In this study, LAA filling velocities in patients in AF were significantly influenced by paced ventricular rate and to a much lesser extent ventricular rhythm. These results suggest that rapid ventricular rates may predispose to stasis in the LAA in AF.

Citing Articles

A novel method to estimate blood flow velocity in the left atrial appendage using enhanced computed tomography: role of Hounsfield unit density ratio at two distinct points within the left atrial appendage.

Yasuoka R, Kurita T, Kotake Y, Akaiwa Y, Hashiguchi N, Motoki K Heart Vessels. 2017; 32(7):893-901.

PMID: 28130587 DOI: 10.1007/s00380-016-0931-x.

Feasibility of In-Vivo Simulation of Acute Hemodynamics in Human Atrial Fibrillation.

Sramko M, Wichterle D, Kautzner J PLoS One. 2016; 11(10):e0165241.

PMID: 27764240 PMC: 5072830. DOI: 10.1371/journal.pone.0165241.

Left atrial appendage exclusion for atrial fibrillation.

Syed F, DeSimone C, Friedman P, Asirvatham S Cardiol Clin. 2014; 32(4):601-25.

PMID: 25443240 PMC: 4458506. DOI: 10.1016/j.ccl.2014.07.006.

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