Abstract
This study was designed to investigate whether administration of digitalis could improve mechanical function of left atrial appendage (LAA) and left atrium prospectively in patients with atrial stunning. Fifty-four consecutive patients in whom atrial stunning was observed immediately after cardioversion of chronic atrial fibrillation (AF) were randomized into digitalis or control group for 1 week following cardioversion. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed prior to, immediately following, 1 day after and 1 week after cardioversion to measure transmitral flow velocity and LAA flow velocity. Electrical cardioversion of AF elicited significantly slower left atrial appendage peak emptying velocity (LAA-PEV) and peak filling velocity (LAA-PFV) immediately following cardioversion in both groups. 1 day post cardioversion, there were no significant differences in transmitral E wave, A wave, E/A ratio, LAA-PEV, LAA-PFV or left atrial appendage ejection fraction (LAA-EF) between digitalis and control groups. 1 week post cardioversion, no significant differences were found in transmitral E wave, A wave, E/A ratio, LAA-PEV, LAA-PFV or LAA-EF between the two groups. The occurrence rates of spontaneous echo contrast were not significantly different between digitalis and control groups one day and one week post cardioversion. In conclusion, digitalis did not improve left atrial and appendage mechanical dysfunction following cardioversion of chronic AF. Digitalis did not prevent the development of spontaneous echo contrast in left atrial chamber and appendage. This may be due to the fact that digitalis aggravates intracellular calcium overload induced by chronic AF and has a negative effect on ventricular rate.
Similar content being viewed by others
References
Grimm, R. A., Stewart, W. J., Maloney, J. D., Cohen, G. I., Pearce, G. L., Salcedo, E. E., et al. (1993). Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: characterization by simultaneous transesophageal echocardiography. Journal of the American College of Cardiology, 22, 1359–1366.
Yang, S., Huang, C., Hu, X., Jin, L., Li, F., & Peng, S. (2003). Predictors of left atrial appendage stunning after electrical cardioversion of non-valvular atrial fibrillation. Chin Med J (Engl), 116, 1445–1450.
Black, I. W., Fatkin, D., Sagar, K. B., Khandheria, B. K., Leung, D. Y., Galloway, J. M., et al. (1994). Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study. Circulation, 89, 2509–2513.
Lévy, S., Ricard, P., Gueunoun, M., Yapo, F., Trigano, J., Mansouri, C., et al. (1997). Low-energy cardioversion of spontaneous atrial fibrillation. Immediate and long term results. Circulation, 96, 253–259.
Khan, I. A. (2003). Atrial stunning: basics and clinical considerations. International Journal of Cardiology, 92, 113–128.
Zapolski, T., & Wysokinski, A. (2005). Stunning of the left atrium after pharmacological cardioversion of atrial fibrillation. Kardiologia Polska, 63, 254–262.
Antonielli, E., Pizzuti, A., Bassignana, A., Tanga, M., Baralis, G., Rovere, M. E., et al. (1999). Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation. American Journal of Cardiology, 84(1092–1096), A9–A10.
DeCara, J. M., Pollak, A., Dubrey, S., & Falk, R. H. (2000). Positive atrial inotropic effect of dofetilide after cardioversion of atrial fibrillation or flutter. American Journal of Cardiology, 86, 685–688.
Sahn, D. J., DeMaria, A., Kisslo, J., & Weyman, A. (1978). Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation, 58, 1072–1083.
Zabalgoitia, M., Halperin, J. L., Pearce, L. A., Blackshear, J. L., Asinger, R. W., & Hart, R. G. (1998). Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. Stroke prevention in atrial fibrillation III investigators. Journal of the American College of Cardiology, 31, 1622–1626.
Leung, D. Y., Grimm, R. A., & Klein, A. L. (1996). Transesophageal echocardiography-guided approach to cardioversion of atrial fibrillation. Progress in Cardiovascular Diseases, 39, 21–32.
Friedman, H. S., Win, M., Hussain, A., & Sinha, A. (2000). Effects of cardiac glycosides on atrial contractile dysfunction after short-term atrial fibrillation. Chest, 118, 1116–1126.
Torp-Pedersen, C., Moller, M., Kober, L., & Camm, A. J. (2000). Dofetilide for the treatment of atrial fibrillation in patients with congestive heart failure. European Heart Journal, 21, 1204–1206.
Baskin, E. P., Serik, C. M., Wallace, A. A., Brookes, L. M., Selnick, H. G., Claremon, D. A., et al. (1991). Effects of new methanesulfonanilide class III antiarrhythmic agents on myocardial refractoriness and contractility in isolated cardiac muscle. Journal of Cardiovascular Pharmacology, 18, 406–414.
Date, T., Takahashi, A., Iesaka, Y., Miyazaki, H., Yamane, T., Noma, K., et al. (2002). Effect of low-dose isoproterenol infusion on left atrial appendage function soon after cardioversion of chronic atrial tachyarrhythmias. International Journal of Cardiology, 84, 59–67.
Wijffels, M. C., Kirchhof, C. J., Dorland, R., & Allessie, M. A. (1995). Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation, 92, 1954–1968.
Goette, A., Honeycutt, C., & Langberg, J. J. (1996). Electrical remodeling in atrial fibrillation: Time course and mechanisms. Circulation, 94, 2968–2973.
Ausma, J., Litjens, N., Lenders, M. H., Duimel, H., Mast, F., Wouters, L., et al. (2001). Time course of atrial fibrillation-induced cellular structural remodeling in atria of the goat. Journal of Molecular and Cellular Cardiology, 33, 2083–2094.
Thijssen, V. L., Ausma, J., & Borgers, M. (2001). Structural remodelling during chronic atrial fibrillation: act of programmed cell survival. Cardiovascular Research, 52, 14–24.
Mihm, M. J., Yu, F., Carnes, C. A., Reiser, P. J., McCarthy, P. M., Van Wagoner, D. R., et al. (2001). Impaired myofibrillar energetics and oxidative injury during human atrial fibrillation. Circulation, 104, 174–180.
Kneller, J., Sun, H., Leblanc, N., & Nattel, S. (2002). Remodeling of Ca(2+)-handling by atrial tachycardia: evidence for a role in loss of rate-adaptation. Cardiovascular Research, 54, 416–426.
Brundel, B. J., van Gelder, I. C., Henning, R. H., Tuinenburg, A. E., Deelman, L. E., Tieleman, R. G., et al. (1999). Gene expression of proteins influencing the calcium homeostasis in patients with persistent and paroxysmal atrial fibrillation. Cardiovascular Research, 42, 443–454.
Van Wagoner, D. R., Pond, A. L., Lamorgese, M., Rossie, S. S., McCarthy, P. M., & Nerbonne, J. M. (1999). Atrial L-type Ca2+ currents and human atrial fibrillation. Circulation Research, 85, 428–436.
Daoud, E. G., Marcovitz, P., Knight, B. P., Goyal, R., Man, K. C., Strickberger, S. A., et al. (1999). Short-term effect of atrial fibrillation on atrial contractile function in humans. Circulation, 99, 3024–3027.
Goette, A., Arndt, M., Röcken, C., Staack, T., Bechtloff, R., Reinhold, D., et al. (2002). Calpains and cytokines in fibrillating human atria. Am J Physiol Heart Circ Physiol, 283, H264–H272.
Leistad, E., Aksnes, G., Verburg, E., & Christensen, G. (1996). Atrial contractile dysfunction after short-term atrial fibrillation is reduced by verapamil but increased by BAY K8644. Circulation, 93, 1747–1754.
Ross, J., Jr, Miura, T., Kambayashi, M., Eising, G. P., & Ryu, K. H. (1995). Adrenergic control of the force frequency relation. Circulation, 92, 2327–2332.
Takagi, M., Doi, A., Shirai, N., Hirata, K., Takemoto, Y., Takeuchi, K., et al. (2005). Acute improvement of atrial mechanical stunning after electrical cardioversion of persistent atrial fibrillation: comparison between biatrial and single atrial pacing. Heart, 91, 58–63.
Chang, C. M., Wu, T. J., Zhou, S., Doshi, R. N., Lee, M. H., Ohara, T., et al. (2001). Nerve sprouting and sympathetic hyperinnervation in a canine model of atrial fibrillation produced by prolonged right atrial pacing. Circulation, 103, 22–25.
Kamp, O., Verhorst, P. M., Welling, R. C., & Visser, C. A. (1999). Importance of left atrial appendage flow as a predictor of thromboembolic events in patients with atrial fibrillation. European Heart Journal, 20, 979–985.
Grimm, R. A., Stewart, W. J., Arheart, K., Thomas, J. D., & Klein, A. L. (1997). Left atrial appendage ‘stunning’ after electrical cardioversion of atrial flutter: an attenuated response compared with atrial fibrillation as the mechanism for lower susceptibility to thromboembolic events. Journal of the American College of Cardiology, 29, 582–589.
Omran, H., Jung, W., MacCarter, D., Schimpf, R., Rabahieh, R., Schumacher, B., et al. (1999). Right atrial thrombi and depressed right atrial appendage function after cardioversion of atrial fibrillation. Echocardiography, 16, 245–251.
Tabata, T., Oki, T., Iuchi, A., Yamada, H., Manabe, K., Fukuda, K., et al. (1997). Evaluation of left atrial appendage function by measurement of changes in flow velocity patterns after electrical cardioversion in patients with isolated atrial fibrillation. American Journal of Cardiology, 79, 615–620.
Harjai, K. J., Mobarek, S. K., Cheirif, J., Boulos, L. M., Murgo, J. P., & Abi-Samra, F. (1997). Clinical variables affecting recovery of left atrial mechanical function after cardioversion from atrial fibrillation. Journal of the American College of Cardiology, 30, 481–486.
Verhorst, P. M., Kamp, O., Welling, R. C., Van Eenige, M. J., & Visser, C. A. (1997). Transesophageal echocardiographic predictors for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. American Journal of Cardiology, 79, 1355–1359.
Dethy, M., Chassat, C., Roy, D., & Mercier, L. A. (1988). Doppler echocardiographic predictors of recurrence of atrial fibrillation after cardioversion. American Journal of Cardiology, 62, 723–726.
Nishino, M., Hoshida, S., Tanouchi, J., Ito, T., Kato, J., Iwai, K., et al. (2000). Time to recover from atrial hormonal, mechanical and electrical dysfunction after successful electrical cardioversion of persistent atrial fibrillation. American Journal of Cardiology, 5, 1451–1454.
Manning, W. J., Silverman, D. I., Katz, S. E., Riley, M. F., Come, P. C., Doherty, R. M., et al. (1994). Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation. Journal of the American College of Cardiology, 23, 1535–1540.
Acknowledgements
This study was supported in part by Grant Q20081208 from the Department of Education of Hubei Province, China. We are indebted to the participants in the Ultrasound Department in First People’s Hospital of Jingzhou for their outstanding commitment and cooperation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yujing, W., Congxin, H., Shaning, Y. et al. Digitalis Does not Improve Left Atrial Mechanical Dysfunction After Successful Electrical Cardioversion of Chronic Atrial Fibrillation. Cell Biochem Biophys 57, 27–34 (2010). https://doi.org/10.1007/s12013-010-9080-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12013-010-9080-5