Implication: Active treatment with class III antiarrhythmic drugs(amiodarone or sotalol) improves 48-hour reversion rates and reducescomplications compared with rate control by digoxin alone.

Bharucha DB, Kowey PR: Management and pre-vention of atrial fibrillation after cardiovascular sur-gery. Am J Card 85:20–24, 2000 (Suppl 1).

Postoperative atrial arrhythmias are common after cardiac surgery.This article discusses incidence, mechanisms, management, and prog-nosis of postoperative atrial arrhythmias. Pharmacologic and nonphar-macologic treatment modalities are discussed.

Implication: Prophylactic therapy for postoperative atrial arrhythmiasis recommended. The frequency of occurrence and ease of treatmentencourage aggressive therapy of postoperative atrial arrhythmias.

Mattioli AV, Vivoli D, Borella P, Mattioli G: Clin-ical, echocardiographic, and hormonal factors influ-encing spontaneous conversion of recent-onset atrialfibrillation to sinus rhythm. Am J Cardiol 86:351–352, 2000

Clinical, hormonal, and echocardiographic factors were evaluated fortheir relationship to spontaneous conversion of recent-onset atrial fibrilla-tion (symptoms �6 hours) to normal sinus rhythm. Patients who devel-oped the arrhythmia during sleep had the highest probability of spontane-ous conversion during the first 24 hours. The plasma concentration of atrialnatriuretic peptide correlated with the duration of the arrhythmia.

Implication: Identification of factors that predispose to early con-version of atrial fibrillation to normal sinus rhythm may help to identifypatients who will not require aggressive pharmacologic treatment.

Ozer N, Tokgozoglu L, Ovunc K, et al: Left atrialappendage function in patients with cardioembolicstroke in sinus rhythm and atrial fibrillation. J AmSoc Echocardiogr 13:661–665, 2000

Adult patients with stroke suspected to be of embolic origin (n � 61)were enrolled and compared with a control group of 37 patients withoutcardioembolic disease and in sinus rhythm. Transthoracic and trans-esophageal echocardiography were performed in all patients. Patientswith stroke were divided into patients in atrial fibrillation (n � 17) andpatients in normal sinus rhythm (n � 44). Patients in atrial fibrillationhad larger left atrial appendage area than patients in sinus rhythm orcontrols. Peak forward flow velocity was lower in atrial fibrillationpatients than in the other 2 groups but was also lower in stroke patientsin sinus rhythm than in control patients.

Implication: Lower peak left atrial appendage flow velocity and leftatrial appendage dysfunction are associated with stroke regardless ofunderlying cardiac rhythm. Enlarged left atrial appendage area wasseen in atrial fibrillation. Further studies are needed to define appro-priate prophylaxis for patients at risk for stroke.

RIGHT VENTRICULAR FUNCTION

Aessopos A, Farmakis D, Taktikou H, LoukopoulosD: Doppler-determined peak systolic tricuspid pres-sure gradient in persons with normal pulmonaryfunction and tricuspid regurgitation. J Am Soc Echo-cardiogr 13:645–649, 2000

Estimation of pulmonary artery pressure by using the right ventricular–right atrial pressure gradient measured echocardiographically has shown

excellent correlation with cardiac catheterization data. The range of valuesin healthy individuals was investigated in this study. Fifty-three healthypersons presenting for routine medical evaluation were recruited for studybecause they had Doppler evidence of tricuspid regurgitation by color flowand continuous wave interrogation. Peak systolic tricuspid gradient was19.3 � 4.0 mmHg. A gradient �20 mmHg was present in 19 (35.8%)subjects. There was no correlation between tricuspid gradient and age orleft ventricular functional indices.

Implication: In patients with a tricuspid regurgitation Doppler sig-nal, a significant measurable gradient may be found in patients withoutdetectable cardiac disease. The upper normal limit for tricuspid gra-dient by this technique should be 30 mmHg.

Mattioli AV, Fini M, Mattioli G: Right ventriculardysfunction after thrombolysis in patients with rightventricular infarction. J Am Soc Echocardiogr 13:655–660, 2000

Patients with right ventricular (RV) infarction, documented by clin-ical, electrocardiographic, hemodynamic, and radiologic criteria, wereincluded in the study. Doppler echocardiography was obtained beforethrombolytic therapy, 2 to 3 hours after thrombolytic therapy and at 1day and 1 month follow-up. Ventricular function was assessed usingRV and left ventricular (LV) end-diastolic diameter, ejection fraction,interventricular septal motion, interatrial septal motion, hepatic veinflow velocity, and tricuspid regurgitation peak velocity. After throm-bolysis, 83 of 108 patients showed a decrease in RV diameter, RVfunctional improvement, LV functional improvement, normalization ofinterventricular septal motion, and normalization of interatrial septalshape, and these improvements were seen at 1-month follow-up. Thesepatients had improved perfusion documented on angiography, com-pared with the patients without echocardiographic improvement. Thegroup with echocardiographic improvement had a 6% mortality com-pared with 36% in the no improvement group.

Implication: Persistent RV dysfunction after thrombolysis can por-tend a poor outcome. This can be diagnosed using echocardiographictechniques.

Mukherjee D, Nader S, Olano A, et al: Improve-ment in right ventricular systolic function after sur-gical correction of isolated tricuspid regurgitation.J Am Soc Echocardiogr 13:650–654, 2000

Chronic tricuspid regurgitation leads to right ventricular (RV) geo-metric distortion and systolic dysfunction. Twelve patients with iso-lated tricuspid regurgitation underwent valvular repair or replacement.Preoperative and postoperative transthoracic echocardiograms werecompared. RV systolic and diastolic areas and volumes were decreasedsignificantly after surgery. RV ejection fraction was improved (0.3 �0.05 v 0.38 � 0.05, p � 0.01). There were no preoperative variablesthat correlated with postoperative RV ejection fraction on multivariateanalysis (except for preoperative ejection fraction).

Implication: The measurable improvement in RV functional indicessuggests the possibility that RV dysfunction may be partly reversible indisease states other than tricuspid regurgitation.

Articles reviewed in this issue were selected from those published inthe following journals: American Heart Journal, American Journal ofCardiology, Annals of Emergency Medicine, Chest, Clinical Cardiol-ogy, and Journal of the American Society of Echocardiography.

Contributions to this section were made by Adam Lichtman, MD,Department of Anesthesiology, Mount Sinai Medical Center, NewYork, NY.

doi: 10.1053/jcan.2001.20366

135LITERATURE REVIEW