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Year : 2018  |  Volume : 2  |  Issue : 3  |  Page : 185-190

Effect of arrhythmias on tissue Doppler velocities

Department of Cardiology, Mittal Hospital and Research Centre, Ajmer, Rajasthan, India

Correspondence Address:
Dr. Sita Ram Mittal
Xi/101, Brahmpuri, Ajmer - 305 001, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiae.jiae_16_18

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Sa wave of tissue Doppler imaging correlates with ventricular systole (QRS-T of electrocardiogram). Ea wave correlates with ventricular filling in early diastole. Aa wave correlates with ventricular filling during atrial contraction and correlates with P wave of electrocardiogram. Therefore, a careful analysis of the relation between Ea and Aa waves gives a correct impression about the underlying cardiac arrhythmia. In sinus bradycardia, all waves are normal, but the distance between Ea and Aa wave is increased. In sinus tachycardia, Aa wave comes closer to Ea wave and may even fuse with Ea wave due to shortened diastole. Prematurely occurring Aa wave suggests atrial premature beat. The absence of Aa wave suggests atrial fibrillation. More than one Aa wave per cardiac cycle suggests atrial flutter. Premature Sa wave suggests ventricular premature beat. Increased distance between Aa wave and Sa wave suggests first-degree atrioventricular (AV) block. Progressive decrease of the distance between Ea and Aa waves till one Aa wave fuses with preceding Ea wave followed by a pause suggests Wenckebach phenomenon. In 2:1 AV block, one Aa wave is fused with Ea wave and the next Aa wave is followed by Sa and Ea waves. Sa and Ea waves occur regularly at a slow rate and Aa wave occurs regularly at a fast rate; thus, total dissociation between Ea and Aa waves suggests complete AV block. Usually, the person performing echocardiography is not aware of electrocardiography (ECG) findings. Clinicians may not be aware of the ECG findings when they are interpreting the tissue Doppler images. Further, arrhythmia recorded during tissue Doppler imaging need not necessarily be present in the 10 s ECG recorded routinely. Knowledge of the effect of arrhythmia on tissue Doppler findings helps in correct interpretation of the tissue Doppler findings.

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