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At least 433 records · Page 24Linked to original sources
PubMed2001

Left atrial appendage flow in nonrheumatic atrial fibrillation : relationship with pulmonary venous flow and ECG fibrillatory wave amplitude.

OBJECTIVE: This study was conducted (1) to examine the relationship between left atrial appendage (LAA) flow velocity and pulmonary venous flow (PVF) variables during nonrheumatic atrial fibrillation (AF), and (2) to determine whether a reduction in LAA flow is reflected by the fibrillatory wave amplitude on the surface ECG. BACKGROUND: Although LAA Doppler echocardiographic signals provide information regarding the velocity and direction of flow only for a localized narrow sample, systolic PVF represents in part the global left atrial function, mainly relaxation. Controversy exists about whether the amplitude of fibrillatory waves recorded on the surface ECG correlates with LAA flow velocity during AF. MEASUREMENTS AND RESULTS: Thirty-three patients (20 men, 13 women; mean [+/- SD] age, 61 +/- 11 years) with nonrheumatic AF undergoing transthoracic and transesophageal echocardiography were studied. A correlation between LAA flow velocity and systolic PVF variables (peak systolic velocity, R: = 0.450, p = 0.009; velocity-time integral of systolic flow, R = 0.491, p = 0.004; systolic fraction of PVF, R: = 0.627, p < 0.0001) was observed. Patients with a low LAA flow profile (< 25 cm/s) had a reduced systolic PVF. Longer AF duration and the occurrence of moderate mitral regurgitation were related to reduced LAA flow. AF was subdivided into coarse (peak-to-peak fibrillatory amplitude > or = 1 mm) or fine (< 1 mm) in standard ECG lead V1. There was no association between the coarseness of AF and the LAA flow profile. CONCLUSION: In patients with nonrheumatic AF, a reduction in LAA flow velocity correlates with a reduction in systolic PVF. These hemodynamic changes are not reflected by the ECG fibrillatory wave amplitude.

Aged↗
PubMed2006

Left atrial appendage-flow velocity predicts cardioversion success in atrial fibrillation.

Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 +/- 0.14 vs 0.27 +/- 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area (p = 0.18) and LAA ejection fraction (p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.

Aged↗
PubMed2006

Atrial fibrillation in hypertrophic cardiomyopathy: mechanisms, embolic risk and prognosis.

Hypertrophic cardiomyopathy (HCM) is associated with an increased incidence of supraventricular and ventricular arrhythmias. Atrial fibrillation (AF) is the most common arrhythmia in HCM with a prevalence of 20% and an annual incidence of two percent per year. Increased left atrial size and volume along with impaired left atrial function confer an increased likelihood of AF. The onset of AF is often accompanied by a decrease in functional status in conjunction with an increased risk of stroke and overall mortality.

Atrial Fibrillation↗
PubMedDate not supplied

What is "congested" in cardiac failure? A newer approach to plain film interpretation of cardiac failure.

The amount and location of intra- and extravascular fluids varies for the type and duration of heart failure. In some instances (acute LHF) pulmonary and systemic blood volume actually diminishes, and in others (chronic LHF) pulmonary blood volume diminishes at the bases while increasing in the upper lobes. It is only in right heart failure that clinically visible "congestion" occurs and the phrase congestive failure should be reserved for right heart failure. It is more valuable clinically for the film reader to analyze which compartments contain increased or diminished fluid and from this analysis, to decide whether the patient is in left, right or biventricular failure and whether this is acute or chronic. Upper lobe engorgement, (flow inversion) is not caused by basal edema, as previously hypothesized, but by reflex vasoconstriction secondary to chronic elevation of left atrial pressure. The mechanism is designed to improve left atrial function.

Acute Disease↗
PubMedDate not supplied

[Diastolic dysfunction in patients with chronic kidney failure on a hemodialysis program].

OBJECTIVE: The aim of this study was to analyse different ultrasound parameters for the assessment of isolated left ventricular diastolic dysfunction (LVDD) in patients with chronic renal failure (CRF) on periodic hemodialysis (HD), comparing pulsed wave Doppler with pulsed tissue Doppler. MATERIALS AND METHODS: Forty-seven patients with CRF on HD (61% were male; mean age was 51.0 +/- 16.5 years, mean HD time--3.7 +/- 3.8 years, 38% had hypertension, 17% had diabetes) were studied by echocardiography (bidimensional, M-Mode, flow pulsed Doppler and tissue Doppler imaging). All patients had symptoms of left heart failure-class II NYHA, were in sinus rhythm and had no symptoms of ischemic heart disease. The presence of abnormal LV regional contractility was the exclusion criteria. According to their mitral inflow profile Doppler characteristics, patients were included in two groups: Group A (E/A > 1; n = 21) and B (E/A < 1; n = 26). We compared: LV dimensions and function, left atrial (LA) dimension. Gaasch index, LV mass index. E and A wave velocities (in flow pulsatile Doppler and tissue Doppler). E/N ratio in tissue Doppler, isovolumetric relaxation time (IVRT) and deceleration time (DT). RESULTS: There were no significant differences in the prevalence of age > or = 65 years male sex, hypertension or diabetes between group A and B patients, and almost all patients were on hemodialytic treatment for more than one year (81% vs 85%: NS). LV hypertrophy was present in almost all group A and B patients (A--95% vs B--85.5%; NS). Group A, compared with group B, had a difference in the Gaasch index (2.45 +/- 0.3 vs 2.08 +/- 0.4; p < 0.05), E wave velocity in flow pulsatile Doppler and tissue Doppler (cm/sec) (110 +/- 27 vs 62 +/- 20; p < 0.001 and 41 +/- 15 vs 28.5 +/- 16; p < 0.05), E/A ratio in tissue Doppler (1.3 +/- 0.4 vs 0.8 +/- 0.3; p < 0.001). IVRT (msec) (80.7 +/- 15.2 vs 113.5 +/- 28.3; p < 0.001) and DT (msec) (189.7 +/- 24 vs 278.2 +/- 17.9; p < 0.001). According to the E'/A' ratio in tissue Doppler, group A patients were divided in another two groups: E'/A' > 1 (13/21--62%) and < 1 (8/21--38%) and a significantly longer IVRT (75.8 +/- 9.3 vs 100.9 +/- 3.2; p < 0.001) and DT (178 +/- 15 vs 240 +/- 20; p < 0.001) and a greater LA dimension (37.6 +/- 6.9 vs 44.6 +/- 6.9; p < 0.05) were found. CONCLUSIONS: Pulsed wave Doppler is the most useful non invasive method for assessment of global diastolic dysfunction. In our study, 17% of the patients had E/A < 1 only in the tissue Doppler study. These patients probably had a pseudonormal mitral pattern.

Adult↗
PubMed1998

[Incidence of thromboembolism after heart valve replacement: modifying factors].

The most important factors influencing thromboembolic rates after valve replacement are: 1) Cardiogenic factors such as left ventricular function, left atrial size and atrial rhythm. 2) Prosthesis-related factors such as type of prosthesis, position of prosthesis, and time after implantation. 3) Patient-related factors such as quality of anticoagulation and gender. 4) Conditions with hypercoagulability.

Cross-Sectional Studies↗
PubMed1984

Simultaneous changes of left ventricular and left atrial size and function in normal subjects during exercise.

We performed dual M-mode exercise echocardiography, which records left ventricular (LV) and left atrial (LA) echocardiograms simultaneously, in 10 normal subjects to investigate mechanisms of cardiac adaptation to dynamic exercise. The LV end-diastolic dimension (EDD) increased significantly as exercise increased from mild to moderate (3-5%, p less than 0.05 and 0.001). At peak exercise the EDD was slightly increased, but it returned to the baseline during recovery. The LV end-systolic dimension (ESD) showed a progressive decrease with the severity of exercise (5-13%, p less than 0.05 and 0.001). It decreased further immediately after exercise (17-20%) and then returned to the resting value. The LV stroke dimension and fractional shortening increased as exercise changed from mild to moderate and reached a plateau at peak exercise. During recovery, they showed a transient increase and then decreased. By contrast, the LA dimensions, both maximum and minimum, increased significantly as exercise changed from mild to moderate (15-16% and 16-19%, p less than 0.01 and 0.001, respectively), but they were lower at peak exercise (12 and 14%). They returned rapidly to the resting values immediately after exercise. Thus, during exercise, LV function is augmented by the Frank-Starling mechanism in combination with increased contractility, while the LA is enlarged to receive the increased venous return accompanying dynamic exercise. These exercise-induced changes in LV performance return gradually to the resting state, but LA size recovers rapidly after the cessation of exercise.

Adolescent↗
PubMed1992

[Clinico-functional correlations of left atrial myocardial excursions in patients with mitral valve defects].

The pre- and intraoperative drug maintenance was evaluated in 50 patients with mitral valvular disease and compared with the types of left atrial myocardial excursions. The maintenance with cardiac glycosides and diuretics was greatly different in 3 groups of patients with various types of left atrial myocardial excursions. In patients with Type I excursions the maintenance was minimal, in those with Type III excursions it was maximal, those with Type II excursions, it was intermediate. It is concluded that the functional characteristics of left atrial myocardial excursions may be used as an indicator of cardiac performance.

Adolescent↗
PubMed1984

The effect of nifedipine on normal and ischemic left ventricular function during atrial pacing stress.

We studied 44 patients (group I: 9 with insignificant disease and group II: 35 with significant coronary artery disease) by nuclear angiography during the controlled increase in heart rate by atrial pacing to evaluate the effect of 20 mg of sublingual nifedipine on left ventricular function. Left ventricular volumes were calculated using count-derived changes: end-diastolic (EDE), end-systolic (ESE), stroke volume (SVE) and cardiac output equivalents (COE) and ejection fraction (EF) and ejection rate (ER) were calculated during basal sinus rhythm (C) and at the maximal atrial pacing (AP) rate with and without nifedipine. In normal subjects, AP decreased ventricular volumes. The administration of nifedipine decreased blood pressure but had no further effect on left ventricular volume. In the ischemic ventricle, AP produced reversible ventricular wall paresis with a smaller decrease in EDE, an increase in ESE and a significant fall in EF. Nifedipine induced a striking improvement in EF and ER. This was probably a consequence of afterload reduction and increased coronary blood flow.

Adult↗
PubMed1983

Cholinergic-sympathetic interactions in the left atrium and left ventricle of conscious dogs.

The extent of cholinergic-sympathetic interaction in the heart was examined in the resting control state and after isoproterenol stimulation in eight conscious dogs. Sonomicrometer crystals and solid-state pressure transducers were implanted in the left atrium and the left ventricle to evaluate mechanical function while heart rate was held constant by atrial pacing. Edrophonium (0.5 mg/kg i.v.) was given as a single dose at rest and during increased sympathetic tone produced by continuous infusion of isoproterenol (0.08 micrograms/kg/min). In the control state, edrophonium administration caused no change in left ventricular dP/dt, fractional shortening or velocity of contraction, but produced significant (P less than .001) decreases in left atrial fractional shortening and contraction velocity. During isoproterenol infusion there were significant increases in dP/dt, the velocity of contraction and fractional shortening in both left atrium and ventricle (P less than .001). Administration of edrophonium during this increase in inotropic state produced significant (P less than .01) decreases in left ventricular dP/dt, fractional shortening and contraction velocity. Moreover, after edrophonium, left atrial fractional shortening and velocity of contraction were decreased to values that were significantly (P less than .001) less than control. Thus, cholinergic stimulation caused selective depression of left atrial systolic function at rest and depression of both left atrial and ventricular function during sympathetic stimulation.

Animals↗
PubMedDate not supplied

Relationship of left atrial pressure and pulmonary venous flow velocities: importance of baseline mitral and pulmonary venous flow velocity patterns studied in lightly sedated dogs.

Prior clinical and animal studies have shown a markedly different relationship between left atrial pressure and the systolic fraction of pulmonary venous flow but have not discussed possible reasons for this discrepancy. To examine the possibility that these disparate results are due to differences in baseline mitral and pulmonary venous flow velocities, we recorded both velocities with left atrial and left ventricular pressure under different loading conditions in eight lightly sedated normal dogs. With constant atrial pacing at 85 beats/min, mean left atrial pressure was increased from 5.3 +/- 1.1 mm Hg at baseline to 16.1 +/- 1.7 mm Hg with volume and methoxamine infusion (p < 0.05). As left atrial pressure increased, the operating compliance of the left atrium decreased, whereas left atrial volumes and ejection fraction increased. Baseline pulmonary venous diastolic flow velocity was larger than systolic velocity (66 +/- 9 versus 36 +/- 11 cm/sec), with the systolic fraction of pulmonary venous flow 31% +/- 8%. With increasing left atrial pressure, pulmonary venous diastolic velocity did not change, but peak systolic velocity (57 +/- 16 cm/sec) and the systolic fraction (48% +/- 9%) both increased (p < 0.05). Changes in pulmonary venous diastolic flow velocity closely followed changes in early diastolic mitral flow velocity (r = 0.85, p < 0.05). Mean left atrial pressure, or change in mean left atrial pressure, was related to the ratio of pulmonary venous systolic to diastolic velocity time integral (r = 0.59 to 0.62, p < 0.01) and the pulmonary venous systolic fraction (r = 0.58 to 0.60; p < 0.01). When expressed as change from baseline, these variables showed even stronger correlations with left atrial pressure (r = 0.72 to 0.76, p < 0.001). These results are consistent with previous animal and clinical results that indicate pulmonary venous diastolic flow is closely related to early mitral flow velocity, whereas systolic flow is determined primarily by left atrial systolic function. The markedly different relationships observed between left atrial pressure and pulmonary venous systolic flow in animal and clinical studies are most likely due to different baseline flow velocity patterns and differences in left atrial systolic reserve. Future studies investigating these relationships should include data on mitral and pulmonary venous flow velocities as well as left atrial size and systolic function.

Animals↗
PubMed1999

[Relationship between the force of left atrial ejection to left ventricular function in arterial hypertension].

UNLABELLED: The left atrial ejection force (LAEF), defined as that force exerted by the left atrium (LA) to accelerate the blood into the left ventricle during atrial systole, is well accepted for the evaluation of LA systolic function. The aim of this study is to determine whether LAEF is a precursor of the impairement of LV systolic function in patients with arterial hypertension (HTN). For that purpose we studied LAEF in 36 patients with HTN (av. age 58 +/- 8 years) with LV hypertrophy (Lvmi > 134 g/m2 for men and > 110 g/m2 for women). LV systolic function estimated by the fractional shortening (FSh) was 35 +/- 4% (28 to 44); 32 normal subjects (NS) were also analyzed. All subjects were submitted to echo and doppler examinations. METHODS: LAEF was obtained by the formula: 1/3 x MVA x (A-vel)2, where MVA is mitral valve area measured by 2D echo while A-vel. is the late diastolic (atrial) mitral velocity. RESULTS: 1. LAEF increased significantly with age in NS (r = 0.78) p < 0.05). Age corrected LEAF was calculated as % LEAF = (actual LAEF/normal LAEF x 100. 2. Compared to NS. % LAEF was lower in HTN (78 + 25%). 3. There was a significant inverse correlation between LAEF and LV wall thickness (r = -0.46) (p < 0.05). 4. % LAEF was 66 +/- 31% in patients with FSh < 33% and 79 +/- 25% in those with FSh > 33% (p < 0.05). 5. In HTN with the duration > 15 years, % LAEF was lower than in patients with < 15 years (62 +/- 25 vs 76 +/- 24) (p < 0.05). CONCLUSIONS: 1. LAEF is decreased in more advance stages of HTN. 2. This impairment is related to LV hypertrophy and to the duration of the disease. 3. LAEF is a sensitive precursor for LV systolic deterioration in patients with hypertension.

Adult↗
PubMed1997

Left atrial systolic and diastolic function after cessation of pacing in tachycardia-induced heart failure.

Studies in the rapid-pacing model of heart failure have shown that left ventricular (LV) systolic function normalizes on cessation of pacing and LV diastolic dysfunction persists, but there is no information regarding atrial function under these conditions. To determine the effects of cessation of pacing on left atrial (LA) systolic and diastolic function, ten dogs with rapid pacing-induced heart failure (250 beats/min for 3-4 wk), six dogs with regression of heart failure (4 wk after cessation of rapid pacing), and seven control dogs were instrumented with LA sonomicrometers and micromanometers. At matched LA pressure, LA ejection (10.2 +/- 3.0 vs. 17.4 +/- 5.5%), reservoir volume fractions (19 +/- 8 vs. 35 +/- 11%), and heart rate-corrected mean normalized systolic ejection rate (1.25 +/- 0.33 vs. 1.60 +/- 0.44 EF/s) were significantly less, and the volume-normalized diastolic stiffness constant (4.9 +/- 0.8 vs. 3.2 +/- 1.1) was significantly greater, in regression versus control dogs; these changes were associated with incomplete regression of LA hypertrophy and a persistent 77.4% increase in beta-myosin heavy chain (beta-MHC) in the LA body. LV systolic function and weight were not significantly different, whereas the time constant of LV relaxation was longer (52.5 +/- 4.4 vs. 40.8 +/- 7.6 ms; P < 0.05) and LV end-diastolic pressure was greater (12.2 +/- 1.8 vs. 7.1 +/- 2.0 mmHg; P < 0.05) in regression compared with control dogs. Thus, unlike the normalization of LV systolic function observed with cessation of rapid pacing, LA systolic function is persistently abnormal, owing in part to persistent LV diastolic dysfunction, residual LA hypertrophy, and MHC isoform switches.

Animals↗
PubMed2005

[Functional assessment of the left atrial appendage with transesophageal echocardiography before and after percutaneous valvotomy in the mitral stenosis].

OBJECTIVE: To assess the effects of the relief of the mitral stenosis by percutaneous ballon valvotomy in the function of the left atrial appendage. METHODS: Twelve patients with symptomatic mitral stenosis, in sinus rhythm, were studied. They were submitted to the transesophageal echocardiogram before and after effective percutaneous ballon valvotomy. Concerning the left atrial appendage, the peak flow velocities and the respective integral of the anterograde and retrograde flow, in addition to the ejection fraction calculated through the planimetry of the area of that structure, were analyzed at the pulsatile Doppler. RESULTS: There was a significant increase of the anterograde flow velocity of the left atrial appendage after percutaneous ballon valvotomy (pre: mean of 0.30 m/s; post: mean of 0.47 m/s; p<0.05) and their respective integrals. The same happened with the retrograde flow velocity (pre: mean of 0.35 m/s, post: mean of 0.53 m/s; p<0.05). There was a tendency of increase of the ejection fraction of the left atrial appendage after the procedure (pre: mean of 20%, post: mean of 31%; p=0.08). CONCLUSION: The effective opening of the stenosed mitral orifice resulting from the percutaneous ballon valvotomy determined an improvement of the flow pattern of the left atrial appendage, which can potentially contribute for the reduction of the embolic risk.

Adolescent↗
PubMed1994

Right atrial MR imaging studies of cadaveric atrial casts and comparison with right and left atrial volumes and function in healthy subjects.

PURPOSE: To assess magnetic resonance (MR) imaging of the right atrium by measuring volumes of right atrial casts and determining right atrial volume cycles in healthy subjects. MATERIALS AND METHODS: Fourteen human cadaveric atrial casts were imaged and right atrial volumes of eight subjects were measured with cardiac-gated cine MR. Volumes were calculated and right and left atrial volumes were compared. RESULTS: Measured volumes of right atrial casts correlated well (r = .99, P < .001) with true volumes with a small underestimation noted (-7.2 mL +/- 2.3 [standard deviation], P < .001). The maximum in vivo right atrial volume averaged 77 mL/m2 +/- 11 of body area. The right atrial reservoir and conduit functions accounted for, on average, 58% and 19%, respectively, of the ventricular stroke volume; the remaining 23% came from atrial contraction. Right-to-left peak volume ratio averaged 1.41 +/- 0.15 (P < .001), and all volume measurements except conduit volumes were statistically significantly larger in the right atrium than the left. CONCLUSIONS: MR imaging provides a reliable means to study right atrial volumes and phasic function.

Adult↗
PubMedDate not supplied

Effect of ageing on the relationship between early diastolic left ventricular function and mitral valve motion.

OBJECTIVE: The relationships between age and diastolic left ventricular function, and age and mitral valve motion were studied. DESIGN: The maximum velocity of circumferential fibre lengthening (negative peak Vcf) of left ventricular function and mitral valve motions, such as mitral valve E and A wave amplitude, D-E and E-F slopes, and their relationships were assessed. SUBJECTS: Twenty young, healthy persons (10 males and 10 females) from 20 to 47 years old (mean 34.5), and 26 older healthy subjects (five males and 21 females) from 62 to 94 years old (mean 80.0) were studied. INTERVENTION: M-mode echocardiography of left ventricular function and mitral valve motion were recorded and digitized for the assessment. MAIN RESULTS: Age showed a significant (P = 0.0001) correlation with negative peak Vcf (r = -0.62), with E wave amplitude (r = -0.83), with D-E slope (r = -0.71) and with E-F slope (r = -0.83). Negative peak Vcf was correlated with E wave amplitude (r = 0.51, P = 0.0007), with D-E slope (r = 0.31, P = 0.058), with E-F slope (r = 0.53, P = 0.0005). Its relations with mitral valve A wave amplitude was r = -0.30, P = 0.17 in the elderly group and r = 0.003, P = 0.99 in the younger group. A significant (P < 0.001) positive, linear correlation was observed between age and mitral A/E ratio (r = 0.82). CONCLUSIONS: The easily measurable mitral valve E-F slope and E wave amplitude can be used to assess early diastolic left ventricular function in ageing. Left atrial contraction appears to play a more important role in the elderly, compensating for the decline in early diastolic left ventricular function.

Adult↗
PubMed1998

Restoration of atrial mechanical function after maze operation in patients with structural heart disease.

BACKGROUND: The maze operation is effective for the restoration of sinus rhythm; however, restoration of atrial mechanical function has not been demonstrated in all patients. METHODS: Maze operations were performed in 32 patients (13 men, 19 women; mean age 47.1 +/- 9.0 years) combined with valvular surgery (n = 25), coronary artery bypass graft (CABG) (n = 3), and others (n = 4). At 1 week, 3 months, 6 months, and 1 year after the operation, prospective serial Doppler echocardiographic examination was carried out to determine the presence of atrial mechanical function. RESULTS: Sinus rhythm was restored and maintained during the follow-up period in 26 (81%) patients; in 22 patients this was due solely to the operation, whereas in four patients an antiarrhythmic agent was needed to maintain sinus rhythm. Another four patients showed paroxysmal atrial fibrillation (AF) despite treatment with an antiarrhythmic agent. Right atrial mechanical function was restored in all 30 patients with sinus rhythm or paroxysmal AF; in 19 (63%) of these, left atrial mechanical function was restored. In patients with restored left atrial mechanical function, peak A velocity (A) and A/E ratio (A/E) of mitral inflow were significantly lower than in the 16 postoperative control patients (A: 0.46 +/- 0.14 m/sec vs 0. 75 +/- 0.29 m/sec, p < 0.01; A/E: 0.40 vs 0.80, p < 0.01). In patients with left atrial mechanical function, the duration of AF was significantly shorter than in patients without left atrial mechanical function (1.9 +/- 2.9 years vs 7.1 +/- 3.0 years, p < 0. 01), but there were no significant differences in left atrial size and volume. CONCLUSIONS: The maze operation could be safely added to standard open heart surgery for the correction of underlying structural heart disease. The rate of conversion to sinus rhythm resulting solely from the operation might be lower than the rates previously reported with only the duration of AF adversely affecting the restoration of left atrial mechanical function. Considering the fact that not all patients converted to sinus rhythm show atrial mechanical function, the role of the maze operation in the prevention of systemic embolism, with subsequent improvement in survival, requires further study.

Adult↗