Key Echocardiography findings in atrial fibrillation patient

Key Echocardiography Findings in atrial fibrillation patient

Echo does not replace ECG for confirmation of AF, but several findings together can make the diagnosis highly likely.

Key echocardiographic indicators:

1. Loss of atrial contraction

There is no A-wave seen on mitral inflow Doppler.

There is no A’ wave on TDI of the mitral annulus.

LV filling is dominated by the E-wave only, and sometimes an L-wave appears in restrictive filling.

2. Irregular ventricular response

Beat-to-beat variation in mitral inflow Doppler E-wave height and deceleration time.

Irregular LVOT stroke volume from one beat to another.

Variable cycle length with no pattern, reflecting irregular R-R intervals mechanically.

3. Left atrial changes suggesting chronic AF

Marked LA enlargement.

Reduced LA emptying function.

Low atrial strain values.

Presence of spontaneous echo contrast or thrombus especially in the appendage on TEE.

4. TEE features strongly supportive

Low appendage emptying velocity often below 20–30 cm/s.

Smoke appearance indicating blood stasis.

Loss of contractile motion of the appendage.

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Difference between new-onset and chronic AF by echo

New and paroxysmal AF often show normal or only mildly enlarged LA size, preserved function, and good appendage velocities.

Chronic AF is more likely when the LA is clearly enlarged, the LAA velocity is very low, there is spontaneous echo contrast, and mitral annular dilatation with possible MR.

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