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Appearance of atrial sound after reversion of atrial fibrillation
Insights
In patients with heart disease, an atrial sound may not appear immediately after restoring normal heart rhythm (sinus rhythm) from atrial fibrillation. This heart sound often develops days later as heart function improves.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Myocardial disease can affect cardiac function and hemodynamics.
- The atrial sound's presence and timing post-AF reversion in these patients are not well-established.
Purpose of the Study:
- To investigate the incidence and onset timing of the atrial sound.
- To correlate atrial sound appearance with cardiac recovery after AF reversion in patients with myocardial disease.
Main Methods:
- Serial auscultation and simultaneous recordings of phonocardiogram, apex cardiogram, and electrocardiogram.
- Follow-up of 16 patients (12 arteriosclerotic heart disease, 4 primary myocardial disease) after AF reversion via DC discharge or quinidine.
- Monitoring for atrial sound development post-reversion.
Main Results:
- All 16 patients developed an atrial sound during sinus rhythm.
- Only 2 patients showed the atrial sound on the day of reversion.
- The remaining 14 patients developed the atrial sound between days 1 and 6 post-reversion (average day 3), with persistent presence.
Conclusions:
- The atrial sound, indicative of diminished ventricular compliance, may be transiently absent immediately after AF reversion in myocardial disease patients.
- Delayed appearance of the atrial sound suggests a gradual improvement in left atrial function and ventricular compliance.
- The atrial sound is a persistent finding in these patients once it appears post-reversion.
Abstract:
To determine the incidence and time of onset of the atrial sound after reversion of atrial fibrillation in patients with myocardial disease, 12 patients with arteriosclerotic heart disease and 4 patients with primary myocardial disease were followed with serial auscultation as well as daily simultaneous apical phonocardiogram, apex cardiogram, and lead II electrocardiogram. Their average age was 52.3 years. Each patient had been in atrial fibrillation for 6 months to 2 years' duration; 13 were reverted to sinus rhythm with DC capacitor discharge and 3 with quinidine sulphate. All 16 patients developed an atrial sound when in sinus rhythm, but only 2 on the day of reversion; the other 14 patients developed an atrial sound on the first to the sixth day after reversion (average third day). The atrial sound persisted in each patient. This study indicates that the atrial sound as a manifestation of diminished ventricular compliance may be absent in patients with myocardial disease immediately after reversion of atrial fibrillation and may later appear as left atrial function improves.