Naslov
Atrial Transport Function Following Atrial Fibrillation Surgery Using Transesophageal Doppler Myocardial Imaging

Autori
Gašparović, Hrvoje ; Čikeš, Maja ; Kopjar, Tomislav ; Bijnens, Bart ; Velagić, Vedran ; Miličić, Davor ; Biočina, Bojan

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, ostalo

Izvornik
Interactive Cardiovascular and Thoracic Surgery 12(suppl.1) / - , 2011

Skup
60th International Congress of the European Society for Cardiovascular and Endovascular Surgery

Mjesto i datum
Moskva, Ruska Federacija, 20.05.2011. - 22.05.2011

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
atrial fibrillation; atrial transport function; radiofrequency ablation for atriall fibrillation; strain rate; tissue velocity imaging

Sažetak
Objective: Controversy still surrounds the issue of atrial transport following the restitution of sinus rhythm (SR) after permanent atrial fibrillation (AF). This matter has profound implications on the continuation of anticoagulation. Spontaneous restitution of SR occurs for a brief period of time in many patients with AF in the early postoperative period. We aimed to determine whether postoperative conversion of AF to SR leads to restoration of atrial contractile function, and whether radiofrequency ablation (RFA) independently impacted atrial function. Methods: We evaluated 20 patients with permanent AF. Eleven patients (64±9 years, EuroSCORE 5±4) underwent a biatrial MAZE procedure. Nine patients with permanent AF (71±8 years, EuroSCORE 9±6) who were briefly in SR intraoperatively, but did not undergo any atrial fibrillation surgery, comprised the non- RFA group. A complete intraoperative TEE study, including Doppler myocardial imaging, was acquired pre- and post- surgical intervention. Tissue velocity (V) and strain rate (SRI) data were acquired at the mid segment of the left atrial lateral wall. Results: Intraoperative baseline ECG demonstrated AF in all patients, while electrical atrial activation was present in all patients at the time of postprocedural data acquisition. Following restoration of atrial activation, atrial contraction was observed in both groups with the atrial contraction SRI being significantly lower in non-RFA group (–1.4±1.2 vs. –0.4±0.7, P<0.05). Atrial tissue velocities during atrial filling were reduced in comparison to preoperative values in the RFA group (–4.3±2.3 vs. –2.1±2.1, P<0.05) but were unaffected in the non-RFA group (–2.8±1.4 vs. –2.8±2.7, P=NS). The reported values of SRI during atrial mechanical activation in healthy individuals are significantly greater than the ones observed in our study. Conclusions: Restoration of atrial activation with subsequent induction of atrial contraction occurs in the early postoperative period. This mechanical transport function occurs with low velocity and deformation both in patients with and without atrial ablation surgery. Atrial electrical activation is not, therefore, synonymous with normal atrial contraction. The termination of anticoagulation therapy in patients who underwent successful AF surgery should, therefore, be individualized, since the ECG appearance of SR does not necessarily translate into complete restoration of atrial transport. Radiofrequency ablation does not further reduce the contractile capacity of the atria in comparison to the atria who have spontaneously converted into SR after permanent AF. Conversely, patients who underwent a biatrial MAZE procedure seemed to have modestly superior late diastolic tissue Doppler imaging profiles. However, the atrial filling seemed impaired after AF surgery.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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