Acute changes in spontaneous echo contrast and atrial function after cardioversion of persistent atrial flutter

Raul Weiss, Pamela Marcovitz, Bradley P. Knight, Marwan Bahu, Joseph J. Souza, Adam Zivin, Rajiva Goyal, Emile G. Daoud, K. Ching Man, S. Adam Strickberger, William F. Armstrong, Fred Morady*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


With use of transesophageal echocardiography, the short-term effects of transthoracic electrical cardioversion of atrial flutter (AFl) on atrial mechanical function and spontaneous echo contrast were determined. Thirty patients who had AFl for a mean of 6.4 ± 12.2 months underwent transthoracic cardioversion. A transesophageal echocardiogram was recorded immediately before cardioversion, and left atrial appendage emptying velocity and spontaneous contrast were assessed serially at 1, 3, and 5 minutes after cardioversion in 28 patients, and also at 8, 10, and 15 minutes after cardioversion in a subgroup of 13 patients. Cardioversion was deferred in 2 patients (7%) because a thrombus was found in the left atrial appendage. Before cardioversion, spontaneous contrast was present in the left atrium in 7 of 28 patients (25%) who underwent cardioversion. The mean left atrial appendage emptying velocity of 54 ± 22 cm/s before cardioversion fell by 26% to 40 ± 25 cm/s at 1 minute after restoration of sinus rhythm (p <0.01). There were no significant changes in the mean left atrial appendage-emptying velocity between 1 and 15 minutes after cardioversion. Within 5 minutes after conversion to sinus rhythm, left atrial spontaneous echo contrast developed de novo or worsened in 12 of the 28 patients (43%). In conclusion, the results of this study demonstrate that persistent AFl may be associated with left atrial thrombi before cardioversion and that cardioversion of AFl is associated with a significant degree of atrial stunning and formation of spontaneous echo contrast.

Original languageEnglish (US)
Pages (from-to)1052-1055
Number of pages4
JournalAmerican Journal of Cardiology
Issue number9
StatePublished - 1998

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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