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Left Atrial Appendage Flow in Nonrheumatic Atrial Fibrillation^*

Relationship With Pulmonary Venous Flow and ECG Fibrillatory Wave Amplitude

^* From the Department of Cardiology, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany.

Correspondence to: Andreas Bollmann, MD, University Hospital Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany; e-mail: andreas.bollmann{at}medizin.uni-magdeburg.de

Objective: This study was conducted (1) to examine the relationship between left atrial appendage (LAA) flow velocity and pulmonary venous flow (PVF) variables during nonrheumatic atrial fibrillation (AF), and (2) to determine whether a reduction in LAA flow is reflected by the fibrillatory wave amplitude on the surface ECG.

Background: Although LAA Doppler echocardiographic signals provide information regarding the velocity and direction of flow only for a localized narrow sample, systolic PVF represents in part the global left atrial function, mainly relaxation. Controversy exists about whether the amplitude of fibrillatory waves recorded on the surface ECG correlates with LAA flow velocity during AF.

Measurements and results: Thirty-three patients (20 men, 13 women; mean [± SD] age, 61 ± 11 years) with nonrheumatic AF undergoing transthoracic and transesophageal echocardiography were studied. A correlation between LAA flow velocity and systolic PVF variables (peak systolic velocity, R = 0.450, p = 0.009; velocity-time integral of systolic flow, R = 0.491, p = 0.004; systolic fraction of PVF, R = 0.627, p < 0.0001) was observed. Patients with a low LAA flow profile (< 25 cm/s) had a reduced systolic PVF. Longer AF duration and the occurrence of moderate mitral regurgitation were related to reduced LAA flow. AF was subdivided into coarse (peak-to-peak fibrillatory amplitude 1 mm) or fine (< 1 mm) in standard ECG lead V1. There was no association between the coarseness of AF and the LAA flow profile.

Conclusion: In patients with nonrheumatic AF, a reduction in LAA flow velocity correlates with a reduction in systolic PVF. These hemodynamic changes are not reflected by the ECG fibrillatory wave amplitude.

Key Words: atrial fibrillation • ECG • left atrial appendage function • pulmonary venous flow • transesophageal echocardiography

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