Echographic assessment of atrial transport, mitral movement, and ventricular performance following electroversion of supraventricular arrhythmias

Abstract

Controversy attends the extent and temporal sequence of improvements in hemodynamic function resulting from the return of atrial contraction following cardioversion of supraventricular arrhythmias. Thus, mitral, left atrial (LA) and left ventricular (LV) echograms were obtained before, and one hr after conversion of supraventricular arrhythmias to normal sinus rhythm, by direct current countershock, in patients with chronic coronary disease or cardiomyopathies without valvular dysfunction. The duration of the rhythm disturbance varied from one day to 5 yr in 22 patients, and was indeterminate in 13. Atrial systole immediately produced prominent mitral 'A' waves with anterior valve excursion of 7.5 mm (range 3 to 12) in 33 of the 35 patients (94%). The two patients with atrial electromechanical dissociation reverted to atrial fibrillation within one week. Cardioversion caused a decline in LA diameter (3.5 to 3.2 cm, P< .001), and a rise in LV end diastolic dimension (5.2 to 5.5 cm,