Case Reports
Differential atrial stunning after electrical cardioversion: An echo tissue doppler case study*

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Abstract

Left atrial stunning after cardioversion is a well-known phenomenon. It has been associated with higher risk of postcardioversion thromboemboli and increased risk of recurrence of atrial fibrillation. We present a case of differential atrial stunning after electrical cardioversion for atrial fibrillation. Diagnosis was made by pulsed wave Doppler of mitral, tricuspid, and pulmonary vein inflow and mitral and tricuspid annuli. Differential mechanical atrial stunning may be a common phenomenon after cardioversion and may suggest difference in right and left atrial transport function. Its prevalence needs to be determined by a large study. Doppler tissue imaging might be routinely used in patients after cardioversion for atrial fibrillation to detect atrial stunning. (J Am Soc Echocardiogr 2001;14:834-7.)

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Case report

A 78-year-old woman with a history of hypertension was admitted with palpitations. There was no history of chest pain, shortness of breath, headache, dizziness, thyroid disease, alcohol intake, or smoking.

Physical examination revealed a heart rate of 72 bpm, irregularly irregular, and blood pressure of 130/80 mm Hg. There was no jugular venous distension. Lungs were clear to auscultation. The heart was irregularly irregular, with point of maximal impulse in the 5th intercostal space. S1 was

Discussion

Atrial stunning after cardioversion is a well-known phenomenon. It has been described with the use of echocardiographic studies with pulsed wave mitral Doppler7 and with pulsed wave Doppler of the left atrial appendage by transesophageal echocardiography.3, 8 Atrial stunning is more commonly seen in patients undergoing electrical versus chemical cardioversion.2 This has also been associated with a higher risk of postcardioversion thromboembolism.3 In addition, the presence of atrial stunning

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  • Electrocardiographic, echocardiographic, and left atrial strain imaging features of a dog with atrial flutter and third-degree atrioventricular block

    2017, Journal of Veterinary Cardiology
    Citation Excerpt :

    These methods have been also used in patients with AFL to better characterize the arrhythmia and atrial mechanical function [5,6]. Recently, TDI and strain have emerged as alternative methods aimed to accurately measure myocardial deformation properties in several cardiovascular disorders, including atrial tachyarrhythmias affecting both humans and horses [7,8]. Indeed these echocardiographic methods have been shown to accurately identify abnormal mechanical atrial function and dyssynchrony in patients with AFL being able not only to predict the areas of atrial muscular abnormalities but also to quantify the degree of myocardial contractile dysfunction as a cause or consequence of the arrhythmia [9].

*

Reprint requests: Tasneem Z. Naqvi, MD, Division of Cardiology, Room 5341, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (E-mail: [email protected]).

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