Abstract
Background
Sequential analysis of atrial electromechanical coupling (P‐A) by Doppler tissue imaging (DTI) might provide important insight into the mechanisms of paroxysmal atrial fibrillation (PAF).
Hypothesis
The purpose of this study was to evaluate P‐A and the dispersion of P‐A, and to analyze the influential factors of P‐A.
Methods
One hundred and ten patients with PAF and 87 normal controls were enrolled. Using DTI, the time intervals from the beginning of P‐wave to the onset of atrioventricular ring motion related to atrial contraction were measured.
Results
Atrial electromechanical coupling at the interventricular septum atrioventricular annulus (P‐A1), left lateral mitral annulus (P‐A2) and right lateral tricuspid annulus (P‐A3) in PAF group were significantly longer than those in control (p < 0.001). The difference between P‐A2 and P‐A1 (T1), P‐A2 and P‐A3 (T3) in PAF group were greater than those in control before age correction (p < 0.05). The linear regression analysis showed that the duration of PAF episodes and age were the greatest influential factors of P‐A1 (r = 0.564). Left atrial anterior‐posterior dimension (LAD) and age were the greatest influential factors of P‐A2 (r = 0.459). The LAD was the greatest influential factors of T1 and T3 (r = 0.408, 0.542).
Conclusions
The atrial electromechanical coupling was significantly longer and the dispersion of P‐A at left lateral mitral annulus was greater in PAF patients. The prolongation of P‐A may be related to left atrial enlargement, long episodes of PAF and aging and the dispersion of P‐A at left lateral mitral annulus to LAD. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: atrial electromechanical coupling, paroxysmal atrial fibrillation, Doppler tissue imaging
Full Text
The Full Text of this article is available as a PDF (72.0 KB).
References
- 1. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, et al.: ACC/AHA/ESC 2006 Guidelines for the management of Patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114(7): e257–e354. [DOI] [PubMed] [Google Scholar]
- 2. Guray U, Guray Y, Yylmaz MB, Mecit B, Sasmaz H, et al.: Evaluation of P wave duration and P wave dispersion in adult patients with secundum atrial septal defect during normal sinus rhythm. Int J Cardiol 2003; 91(1): 75–79. [DOI] [PubMed] [Google Scholar]
- 3. Hashiba K, Tanigawa M, Fukatani M, Shimizu A, Konoe A, et al.: Electrophysiologic properties of atrial muscle in paroxysmal atrial fibrillation. Am J Cardiol 1989; 64(20): 20J–23J. [DOI] [PubMed] [Google Scholar]
- 4. Fukunami M, Yamada T, Ohmori M, Kumagai K, Umemoto K, et al.: Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave‐triggered signal‐averaged electrocardiogram. Circulation 1991; 83(1): 162–169. [DOI] [PubMed] [Google Scholar]
- 5. Engel TR, Vallone N, Windle J: Signal‐averaged electrocardiograms in patients with atrial fibrillation or flutter. Am Heart J 1988; 115(3): 592–597. [DOI] [PubMed] [Google Scholar]
- 6. Barbier PAG, Guazzi MD: Left atrial function and ventricular filling in hypertensive patients with paroxysmal AF. J Am Coll Cardiol 1994; 24: 165–170. [DOI] [PubMed] [Google Scholar]
- 7. Nishimura RAAM, Halte LK, Tajik AJ: Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography; part II, clinical studies. Mayo Clin Proc 1989; 64: 181–204. [DOI] [PubMed] [Google Scholar]
- 8. Rein AJ, O'Donnell CP, Colan SD, Marx GR: Tissue velocity Doppler assessment of atrial and ventricular electromechanical coupling and atrioventricular time intervals in normal subjects. Am J Cardiol 2003; 92(11): 1347–1350. [DOI] [PubMed] [Google Scholar]
- 9. Edvardsen T, Urheim S, Skulstad H, Steine K, Ihlen H, et al.: Quantification of left ventricular systolic function by tissue Doppler echocardiography: added value of measuring pre‐ and postejection velocities in ischemic myocardium. Circulation 2002; 105(17): 2071–2077. [DOI] [PubMed] [Google Scholar]
- 10. Garcia MJ, Rodriguez L, Ares M, Griffin BP, Klein AL, et al.: Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J 1996; 132(3): 648–656. [DOI] [PubMed] [Google Scholar]
- 11. Nii M, Shimizu M, Roman KS, Konstantinov I, Li J, et al.: Doppler tissue imaging in the assessment of atrioventricular conduction time: validation of a novel technique and comparison with electrophysiologic and pulsed wave Doppler‐derived equivalents in an animal model. J Am Soc Echocardiogr 2006; 19(3): 314–321. [DOI] [PubMed] [Google Scholar]
- 12. Omi W, Nagai H, Takamura M, Okura S, Okajima M, et al.: Doppler tissue analysis of atrial electromechanical coupling in paroxysmal atrial fibrillation. J Am Soc Echocardiogr 2005; 18(1): 39–44. [DOI] [PubMed] [Google Scholar]
- 13. Allessie M, Ausma J, Schotten U: Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 2002; 54(2): 230–246. [DOI] [PubMed] [Google Scholar]
- 14. Schotten U, Neuberger HR, Allessie MA: The role of atrial dilatation in the domestication of atrial fibrillation. Prog Biophys Mol Biol 2003; 82(1–3): 151–162. [DOI] [PubMed] [Google Scholar]
- 15. Daubert JC, Pavin D, Jauvert G, Mabo P: Intra‐ and interatrial conduction delay: implications for cardiac pacing. Pacing Clin Electrophysiol 2004; 27(4): 507–525. [DOI] [PubMed] [Google Scholar]