Relation of Fibrillatory Wave Amplitude With Hemostatic Abnormality and Left Atrial Appendage Dysfunction in Patients With Chronic Nonrheumatic Atrial Fibrillation.

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  • Nakagawa Keiko
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Hirai Tadakazu
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Shinokawa Noriko
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Uchiyama Yoshiko
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Kameyama Tomoki
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Takashima Shutaro
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Fujiki Akira
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Asanoi Hidetsugu
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University
  • Inoue Hiroshi
    The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

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Abstract

Large left atrium (LA) and LA appendage (LAA) dysfunction are known to relate to cardiogenic thromboembolism, so the present study investigated the relation of the atrial fibrillatory wave (F wave) amplitude to hemostatic markers and LAA function. Transthoracic and transesophageal echocardiographic studies were performed in 82 consecutive patients with chronic, nonrheumatic atrial fibrillation (AF). Patients were divided into 2 groups according to F wave amplitude in lead V1 on the 12-lead ECG: coarse AF (the greatest amplitude of F wave ≥1 mm, n=44) and fine AF (<1 mm, n=38). Plasma levels of thrombin-antithrombin III complex, D-dimer, platelet factor 4 and β-thromboglobulin were determined. Compared with patients with coarse AF, those with fine AF had lower LAA peak flow velocity (p<0.05) and higher prevalence of embolic cerebral infarction (50% vs 27%, p<0.05). Platelet activity did not differ between the 2 groups; however, plasma levels of thrombin - antithrombin III complex and D-dimer were significantly higher in patients with fine AF than in those with coarse AF (p<0.05). Multiple logistic regression analysis showed that fine AF was independently associated with cerebral embolism. Therefore, the presence of fine F wave in V1 would be a useful marker of LAA dysfunction and hypercoagulability, and indicate a risk for cerebral embolism in patients with chronic, nonrheumatic AF. (Jpn Circ J 2001; 65: 375 - 380)

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