Predictors of left atrial appendage stunning after electrical cardioversion in patients with atrial fibrillation

Int J Cardiovasc Imaging. 2019 Sep;35(9):1549-1555. doi: 10.1007/s10554-019-01592-y. Epub 2019 Apr 2.


The transient left atrial appendage (LAA) dysfunction after electrical cardioversion (CV), which is called as LAA-stunning, was found to be an important etiology of thrombus formation. The aim of the present study was to investigate the risk factors of LAA-stunning. This study included 134 patients who underwent catheter ablation for non-paroxysmal, non-valvular, and symptomatic atrial fibrillation (AF). Internal-CV was performed, and LAA emptying fraction (LAA-EF) was assessed using LAA-angiogram before and just after CV. LAA-stunning (defined as 10% reduction of LAA-EF after CV) was observed in 45/134 patients (34%). Patients in LAA-stunning group had longer duration of AF prior to CV, higher brain natriuretic peptide (BNP), higher prevalence of patients taking calcium blocker, larger left atrial (LA) diameter, elevated E wave, and larger LA volume than those in non LAA-stunning group. Multivariate analysis showed that longer duration of AF prior to CV (p = 0.015, OR 1.033 for 1 month extend, 95% CI 1.006-1.073) and elevated BNP (p = 0.038, OR 1.041 for each 10 pg/mL increase, 95% CI 1.001-1.009) were associated with LAA-stunning. In addition, all patients were divided into four groups based on the combination between duration of AF prior to CV and BNP; group 1 (low BNP/short-lasting AF), group 2 (high BNP/short-lasting AF), group 3 (low BNP/long-lasting AF), and group 4 (high BNP/long-lasting AF). The rate of LAA-stunning was the highest in the group 4 (55.6%). Elevated BNP and long duration of AF were associated with LAA stunning after electrical cardioversion.

Keywords: Atrial fibrillation; Left atrial appendage; Stunning.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anti-Arrhythmia Agents / administration & dosage
  • Atrial Appendage / diagnostic imaging
  • Atrial Appendage / physiopathology*
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Atrial Function, Left*
  • Biomarkers / blood
  • Calcium Channel Blockers / administration & dosage
  • Drug Administration Schedule
  • Echocardiography
  • Electric Countershock / adverse effects*
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Stunning / diagnostic imaging
  • Myocardial Stunning / etiology*
  • Myocardial Stunning / physiopathology
  • Natriuretic Peptide, Brain / blood
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Up-Regulation


  • Anti-Arrhythmia Agents
  • Biomarkers
  • Calcium Channel Blockers
  • Natriuretic Peptide, Brain