CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 2021 16_5-6_19910.15836/ccar2021.199Extended AbstractLeft atrial mechanical standstill after electrical cardioversion for atrial flutter: a case reporthttps://orcid.org/0000-0001-8359-3910Zaninović JurjevićTeodora1*https://orcid.org/0000-0002-7136-8123AvdovićErvin1PremušDanijel2https://orcid.org/0000-0003-1583-8116Lanča BastiančićAna2https://orcid.org/0000-0002-5767-1206AntonićAna1https://orcid.org/0000-0003-2246-0908ĆutićLea Skorup1https://orcid.org/0000-0002-0035-4445Grgić RomićIvana1https://orcid.org/0000-0002-8937-437XLulićDavorka1https://orcid.org/0000-0002-1880-1493Rubeša MiculinićŽeljka1https://orcid.org/0000-0002-9668-291XSmoljanIvana1https://orcid.org/0000-0002-9050-5314BačićGordana1Flego BojićAnamarija1https://orcid.org/0000-0001-5031-2975RužićAlen1https://orcid.org/0000-0001-9415-9618ZaputovićLuka1University of Rijeka, Faculty of Medicine, University Hospital Centre Rijeka, Rijeka, CroatiaClinic for rehabilitation, treatment and prevention of diseases of the heart and blood vessels, Opatija, CroatiaADDRESS FOR CORRESPONDENCE: Teodora Zaninović Jurjević, Klinički bolnički centar Rijeka, Tome Strižića 3, HR-51000 Rijeka, Croatia. / Phone: + 385-98-320-768 / E-mail: teodorazj@gmail.com042021165-619919928032021020420212021Croatian Cardiac SocietyKEYWORDS: atrial flutteratrial standstillelectrical cardioversionprognosis
Introduction: Atrial mechanical standstill is a rare phenomenon. Electrical function is preserved but atrial contraction is absent. Standard 2D transthoracic echocardiography evaluates isolated left atrial standstill by analyzing pulsed-wave Doppler imaging of mitral valve (MV) inflows and tissue Doppler imaging (TDI) at MV annulus.
Case report: In a 65-year old patient with arterial hypertension and hyperlipidemia electrical conversion of persistent atrial flutter to sinus rhythm was achieved. The patient has had atrial flutter for about a year. He also suffered from COVID-19 pneumonia infection 2 months before being admitted to the hospital. In spite of sinus rhythm after the electrical conversion that was seen on twelve-lead electrocardiography, 48 hours after conversion no mechanical left atrial activity was restored. MV inflow demonstrated normal E wave (passive filling in early diastole) but absent A wave (atrial contraction during late diastole). TDI at the MV annulus also confirmed isolated mechanical LA standstill. There was absence of a’ at the MV annulus.
Conclusion: Atrial standstill is condition that may involve impairment of electrical function (electrical silence or an inability to pace or capture), or mechanical function (based on imaging). (1, 2) The pathophysiologic mechanism can be the underlying presence of atrial fibrosis, myopathy or it may include interatrial block. (3) The absence of mechanical LA contraction has potential hemodynamic consequences, also there could be the possibility for the thrombus formation within the atria leading to thromboembolism. That is why anticoagulation should be continued. (4)
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