
Assessment of atrial electromechanical interval using echocardiography after catheter ablation in patients with persistent atrial fibrillation
Xiaodong Chen, Minglong Chen, Yingying Wang, Bing Yang, Weizhu Ju, Fengxiang Zhang, Kejiang Cao
Journal of Biomedical Research ›› 2016, Vol. 30 ›› Issue (6) : 483-489.
Assessment of atrial electromechanical interval using echocardiography after catheter ablation in patients with persistent atrial fibrillation
We sought to investigate variation of atrial electromechanical interval after catheter ablation procedure in patients with persistent atrial fibrillation using pulse Doppler (PW) and pulse tissue Doppler imaging (PW-TDI). A total of 25 consecutive in-patients with persistent atrial fibrillation, who restored sinus rhythm after ablation procedure, were recruited in our cardiac center. Echocardiography was performed on each patient at 2 hours, 1 day, 5 days, 1 month and 3 months after the ablation therapy, and atrial electromechanical delay was measured simultaneously by PW and PW-TDI. There was no significant difference between PW and TDI in measuring atrial electromechanical delay. However, at postoperative 2 hours, peak A detection rates were mathematically but nonsignificantly greater by PW-TDI than by PW. Second, there was a significant decreasing trend in atrial electromechanical interval from postoperative 2 hours to 3 months, but only postoperative 2-hour atrial electromechanical interval was significantly greater than atrial electromechanical interval at other time. Lastly, patients without postoperative 2-hour atrial electromechanical interval had a significantly longer duration of atrial fibrillation as compared to those with postoperative 2-hour atrial electromechanical interval, by the PW or by PW-TDI, respectively. In patients with persistent atrial fibrillation, atrial electromechanical interval may decrease significantly within the first 24 hours after ablation but remain consistent later, and was significantly related to patients' duration of atrial fibrillation. Atrial electromechanical interval, as a potential predicted factor, is recommended to be measured by either PW or TDI after 24 hours, when patients had recovered sinus rhythm by radiofrequency ablation.
atrial fibrillation / echocardiography / tissue Doppler imaging / atrial electromechanical interval
Tab.1 Demographic characteristics and echocardiographic measurements of the study subjects (n = 25) |
Characteristics | Mean±SD | |
---|---|---|
Age, years | 55.4±11.7 | |
Male gender, n (%) | 18 (72) | |
Body mass index, Kg/m2 | 25.31±3.46 | |
Diabete mellitus, n (%) | 3 (12) | |
Hypertension, n (%) | 13 (52) | |
Duration of PAF, months | 13.56±15.73 | |
CHA2DS2-VASc | 1.0±0.707 | |
Treatment | ||
ACE-I/ARB, n (%) | 8 (32) | |
β-blockers, n (%) | 6 (24) | |
Calcium channel blocker, n (%) | 7 (28) | |
Echocardiographic measurements | ||
LAD, mm | 40.28±4.82 | |
LAVI, mL/m2 | 27.04±11.19 | |
IVEDD, mm | 10.32±1.14 | |
LVEDD, mm | 47.72±3.79 | |
LVEF, % | 60.96±5.58 |
Values are means±SD for quantitative variables and numbers with percentages in parenthetic for qualitative variables. PAF: persistent atrium fibrillation; LAD: left atrial diameter; LAVI: left atrial volume index; IVEDD: inter ventricular end-diastolic diameter; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular eject fraction. |
Fig.1 Atrial electromechanical interval measured by pulse-wave Doppler imaging (A) and tissue Doppler imaging (B) at different time points after ablation therapy.Atrial electromechanical interval are shown as in patients with (black circle with solid line) and without 2-h AEI (white circle with dashed line), separately. The P values for AEI trend at different time after ablation were tested by the ANOVA, and Duncan method was applied to calculate the interclass differences. * indicates the interclass differences reach statistical significance. Tissue Doppler imaging has a higher possibility to detect patients' 2-h-AEI than pulse-wave Doppler imaging (20/25 vs. 14/25, P = 0.06). |
Tab.2 Atrial electromechanical delays by pulse Doppler and tissue Doppler at different time points after ablation therapy |
Follow-up | PW-PA interval, ms | TDI-PA interval, ms |
---|---|---|
2h after operation | 183.49±43.93 | 170.13±37.98 |
1 day after operation | 145.69±20.87 | 146.72±18.62 |
3 days after operation | 144.89±22.40 | 147.48±19.74 |
1 month after operation | 148.03±20.67 | 147.97±22.26 |
3 months after operation | 148.76±19.17 | 148.75±21.80 |
Values are means±SD. Students' t test was applied to compare the atrial electromechanical delays measured by pulse Doppler and tissue Doppler at different time after ablation therapy. P values for the comparison between two methodology are all>0.05. |
Tab.3 Comparison of cardiovascular risks and echocardiographic measurements between patients with and without 2-hour-AEI |
Pulse-wave Doppler imaging | Tissue Doppler imaging | ||||||
---|---|---|---|---|---|---|---|
Patients with 2-h-LAEI (n = 14) | Patients without 2-h-AEI (n= 11) | P | Patients with 2-h-AEI (n = 20) | Patients without 2-h-AEI (n= 5) | P | ||
Age, years | 55.2±13.7 | 55.7±9.3 | 0.92 | 57.0±12.1 | 49.4±8.4 | 0.20 | |
Male gender, n (%) | 11 (78.6) | 7 (63.6) | 0.41 | 14 (7.0) | 4 (80.0) | 0.66 | |
Body mass index, kg/m2 | 24.8±2.7 | 25.9±4.3 | 0.44 | 25.0±3.4 | 26.6±3.9 | 0.36 | |
Duration of PAF, months | 8.1±10.6 | 20.5±10.8 | 0.0497 | 9.6±13.0 | 29.6±16.6 | 0.008 | |
Hypertension, n (%) | 7 (50.0) | 7 (63.6) | 0.71 | 11 (55.0) | 3 (60.0) | 0.99 | |
Diabetes, n (%) | 2 (14.3) | 1 (9.1) | 0.99 | 2 (10.0) | 1 (20.0) | 0.50 | |
CHA2DS2-VASc | 0.93±0.73 | 1.09±0.70 | 0.58 | 25.4±7.9 | 33.8±19.5 | 0.40 | |
LAVI,mL/m2 | 26.0±8.8 | 28.4±14.0 | 0.60 | 1.00±0.73 | 1.00±0.71 | 1.00 | |
LAD, mm | 39.9±4.0 | 40.7±5.9 | 0.69 | 39.2±4.3 | 44.6±4.8 | 0.02 | |
IVSEDWT, mm | 10.2±1.2 | 10.5±1.1 | 0.61 | 10.5±1.1 | 9.6±0.9 | 0.12 | |
LVDd, mm | 47.0±3.9 | 48.6±3.6 | 0.29 | 47.3±3.7 | 49.6±3.6 | 0.22 | |
LVEF, % | 61.0±5.5 | 60.9±5.9 | 0.97 | 61.1±4.8 | 61.1±4.8 | 0.88 |
Values are means±SD for quantitative variables and numbers with percentages in parenthetic for qualitative variables. Students' t test and chi-square test were applied to compare the differences in cardiovascular risk factors and echocardiographic measurements between patients with and without 2-hour-AEI for quantitative and qualitative variables, respectively. LAD: left atrial diameter; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular eject fraction. |
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