Left Atrial Mechanical Function : Pre Ablation Examination
-Comprehensive echo with LA strain and LA EF in addition to standard measurements (including LA volume index).
-If patient has had a full exam in the previous six months, obtain only the post ablation parameters and charge accordingly.
-If patient is currently in atrial fibrillation, do not obtain LA strain data. LAMF : One Day Post Ablation And Three Month Follow Up
-Limited 2D for EF, RWMA and to rule out pericardial effusion.
-Limited PW Dopper of MV Inflow and mitral annulus tissue Doppler to show if atrial contraction is present (not for diastolic assessment).
-Color flow of LA and pulmonary veins to look for stenosis.
-Color flow to assess for presence of TR (velocity not needed).
-Apical 4 Chamber and 2 Chamber views with LA EF.
-LA volume index.
-Atrial strain (LA Inferior Wall) [2 Chamber]. Left Atrial Ejection Fraction
=Measurement of largest and smallest LA volumes in apical 4 and 2 chamber vies
=Measure smallest volume after atrial systole (between P wave and QRS.
=Calculate LAEF by biplane volumes on echo machine.
=Normal LAEF ≥ 60% Left Atrial Strain Imaging
Measure atrial strain of inferior wall in 2 chamber view
-Increase gain of ECG so P wave is evident -Select “Q-analysis” -Select “More”, then select “Strain” -Adjust left red bracket on ECG by rotating “Start Strain” knob -Move first (left) red bracket to onset of P wave -Measure peak downward deflection, peak strain should be after P wave and before QRS Atrial Mechanical Function : Left Atrial Ejection Fraction Biplane
=Acquire apical 4 chamber and 2 chamber of LA (avoid foreshortened view) =Measure largest and smallest LA volumes =Largest volume should be measured at end ventricular diastole =Smallest volume should be measured after atrial systole =ECG timing of the smallest volume should be between P wave and QRS =Calculate LAEF by biplane volumes on echo machine Atrial Mechanical Function : A’ (From Medial/Septal Annulus TDI)
· Measure and record A’ Atrial Mechanical Function : A Velocity
· Measure and record A velocity on PW from mitral inflow Atrial Mechanical Function : Atrial Strain
-Use LA view on apical 4 Chamber and apical 2 Chamber.
-Select Octave Strain preset.
-Acquire 5 beat clip of apical 4 Chamber and 2 Chamber with TDI, include whole atria in sector (avoid foreshortened views).
-If A wave not present or not well defined with Doppler, acquire M-Mode of mitral valve (Parasternal Long Axis View) for timing of mitral valve opening (MVO) and mitral valve closure (MVC).
-Go to event timing in the measurement package.
-Mark MVO ad MVC timing on the frozen or stored M-Mode clip (there is no need to store this clip).
-Measure atrial strain of the lateral wall in the 4 chamber view and the inferior wall in the 2 chamber view.
-Use the previously acquired clip of the A4Ch and A2Ch with TDI -Select “Q-analysis”.
-Select “More”, then select “Strain”.
-Adjust left red bracket on ECG by rotating “Start Strain” knob.
-Move first (left) red bracket to onset of P wave.
-Measure peak downward deflection, peak strain should be after P wave and before QRS.
-Sample volume location should be in the middle of the lateral and inferor LA walls.
-Don’t get too close to MV annulus or left upper pulmonary vein.
-If two peaks are present, choose the bigger (should be in late diastole).
-Store strain curve (DICOM image) as a digital clip in the clinical study.
-Report atrial strain of lateral and inferior wall.
-Normal LA Strain Value ≥ 15%