Left But Not Right Ventricular Abnormal Doppler Waves
A B S T R A C T
The presence of a normal atrial electrical activity together with the absence of mechanical atrial activity has been reported after successful cardioversion and is named atrial stunning. In this observation, we report the existence of left but not right atrial stunning.
Keywords
Atrial stunning, cardioversion
Introduction
A 70 years old patient was referred to the Echolab for transthoracic echocardiography (TTE) on December 2018 the 21st. His past medical history included persistent atrial fibrillation and dyslipidemia. Past ECG revealed atrial fibrillation with a ventricular rate of 90/min, and no ST-T alteration. Because, he complained of mild dyspnea (class II), a strategy focused on rhythm-control was proposed and he underwent successful electrical cardioversion on December 2018 the 20th.His actual treatment includes apixaban 5mg BID, amiodarone 200mg SID and rosuvastatine 10 mg SID.TTE showed normal ventricular dimension and ejection fraction, no significant valvular regurgitation. Pulsed doppler analysis tricuspid and mitral patterns are presented on (Figure 1), pulsed tricuspid and mitral annulus Doppler Tissue Imaging (DTI) on (Figure 2). An ECG was performed immediately after the echo and showed normal sinus rhythm.
Discussion
The atria contribute up to 30% of left ventricular filling and cardiac output, and its mechanical activity is represented by the A wave on doppler inflow [1]. Several studies have shown a dissociation between normal electrical activity and a transient atrium and atrial appendage mechanical dysfunction after successful cardioversion; this phenomenon is named mechanical stunning. It may occur up to 30-80% after conversion of atrial fibrillation, immediately after the cardioversion, and improves progressively over time with complete resolution generally observed within weeks [2]. Increased atrial dimensions and prolonged duration of atrial fibrillation worsen the severity and duration of mechanical stunning in contrary to reduced left ventricular ejection fraction [2-4]. Tachycardia-induced atrial cardiomyopathy, cytosolic calcium accumulation, and atrial hibernation are the suggested mechanisms of atrial stunning [3].
Our observation is singular as we report normal ECGH together with normal right atria mechanical activity, and the absence of left atrial mechanical activity after cardioversion, suggesting a left but not right atria mechanical stunning. This has been only exceptionally reported and is attributed to a lower pressure/volume overload of the right atria when compared to the left during atrial fibrillation and thus less structural alterations in the right atria [5]. The rare normalization of right mechanical activity together with persistent left atrial stunning may explain the occurrence of pulmonary edema after successful cardioversion.
Figure 1: Pulsed doppler analysis tricuspid and mitral patterns.
Figure 2: Pulsed tricuspid and mitral annulus Doppler Tissue Imaging (DTI).
Article Info
Article Type
Research ArticlePublication history
Received: Thu 05, Sep 2019Accepted: Mon 11, Nov 2019
Published: Fri 12, Jun 2020
Copyright
© 2023 Christophe Meune. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.DOI: 10.31487/j.JICOA.2019.04.01
Author Info
Christophe Meune François-Xavier Goudot Sonia MSadek Tanissia Boukertouta
Corresponding Author
Christophe MeuneCardiology Department, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
Figures & Tables
References
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