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Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion

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Abstract
It is often suggested but never proven that atrial function is not affected during atrial flutter, nor after its conversion to normal sinus rhythm. To evaluate this hypothesis, a prospective study was performed in 22 patients (age range 20 to 88 years) with atrial flutter. Diastolic transmitral flow was analyzed with echo-Doppler before and after conversion. After randomization, conversion was attempted with overdrive pacing or up to two 50 J shocks. If the initial method was unsuccessful, a 200 J shock was administered. All patients were converted to sinus rhythm with this protocol. Shortly after conversion (at 1 and 6 hours), atrial contribution to ventricular filling was absent in 4 of 22 patients. In the remaining 18 patients, atrial contribution to transmitral flow improved from 20 to 27% within 24 hours (p<0.01) and increased further to 38% at 6 weeks (p<0.005). Peak velocity of late diastolic filling increased from 0.28 m/s after 1 hour to 0.39 m/s after 24 hours (p <0.0001) and improved even further during later follow-up. In 1 patient, an effective atrial systole was not observed until the 14th day. Cardiac output did not change significantly during the study period. No differences were observed between the conversion modalities. In conclusion, atrial dysfunction is present immediately after conversion of atrial flutter to normal sinus rhythm. This dysfunction occurs also after overdrive pacing and can last >1 week. The findings suggest that stasis in the atria can remain temporarily present after successful conversion of atrial flutter to sinus rhythm.
Keywords
FIBRILLATION, MECHANICAL FUNCTION, TERMINATION, ENTRAINMENT

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Chicago
Jordaens, Luc, Luc Missault, Eric Germonpré, Benedict Callens, LUC ADANG, Johan Vandenbogaerde, and Denis Clement. 1993. “Delayed Restoration of Atrial Function After Conversion of Atrial Flutter by Pacing or Electrical Cardioversion.” American Journal of Cardiology 71 (1): 63–67.
APA
Jordaens, Luc, Missault, L., Germonpré, E., Callens, B., ADANG, L., Vandenbogaerde, J., & Clement, D. (1993). Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion. AMERICAN JOURNAL OF CARDIOLOGY, 71(1), 63–67.
Vancouver
1.
Jordaens L, Missault L, Germonpré E, Callens B, ADANG L, Vandenbogaerde J, et al. Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion. AMERICAN JOURNAL OF CARDIOLOGY. 1993;71(1):63–7.
MLA
Jordaens, Luc, Luc Missault, Eric Germonpré, et al. “Delayed Restoration of Atrial Function After Conversion of Atrial Flutter by Pacing or Electrical Cardioversion.” AMERICAN JOURNAL OF CARDIOLOGY 71.1 (1993): 63–67. Print.
@article{200577,
  abstract     = {It is often suggested but never proven that atrial function is not affected during atrial flutter, nor after its conversion to normal sinus rhythm. To evaluate this hypothesis, a prospective study was performed in 22 patients (age range 20 to 88 years) with atrial flutter. Diastolic transmitral flow was analyzed with echo-Doppler before and after conversion. After randomization, conversion was attempted with overdrive pacing or up to two 50 J shocks. If the initial method was unsuccessful, a 200 J shock was administered. All patients were converted to sinus rhythm with this protocol. Shortly after conversion (at 1 and 6 hours), atrial contribution to ventricular filling was absent in 4 of 22 patients. In the remaining 18 patients, atrial contribution to transmitral flow improved from 20 to 27\% within 24 hours (p{\textlangle}0.01) and increased further to 38\% at 6 weeks (p{\textlangle}0.005). Peak velocity of late diastolic filling increased from 0.28 m/s after 1 hour to 0.39 m/s after 24 hours (p {\textlangle}0.0001) and improved even further during later follow-up. In 1 patient, an effective atrial systole was not observed until the 14th day. Cardiac output did not change significantly during the study period. No differences were observed between the conversion modalities. In conclusion, atrial dysfunction is present immediately after conversion of atrial flutter to normal sinus rhythm. This dysfunction occurs also after overdrive pacing and can last {\textrangle}1 week. The findings suggest that stasis in the atria can remain temporarily present after successful conversion of atrial flutter to sinus rhythm.},
  author       = {Jordaens, Luc and Missault, Luc and Germonpr{\'e}, Eric and Callens, Benedict and ADANG, LUC and Vandenbogaerde, Johan and Clement, Denis},
  issn         = {0002-9149},
  journal      = {AMERICAN JOURNAL OF CARDIOLOGY},
  keyword      = {FIBRILLATION,MECHANICAL FUNCTION,TERMINATION,ENTRAINMENT},
  language     = {eng},
  number       = {1},
  pages        = {63--67},
  title        = {Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion},
  url          = {http://dx.doi.org/10.1016/0002-9149(93)90711-K},
  volume       = {71},
  year         = {1993},
}

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