Biplane assessment of left ventricular function during atrial fibrillation at beats with equal subsequent cycles

Background: Prior study has demonstrated that the biplane single-beat method could be used to assess left ventricular function during atrial fibrillation at a beat with equal subsequent cycles. The study was to test whether we could improve the method by measuring a few beats with equal subsequent cycles and cycle-length limits. Methods: In 75 patients with atrial fibrillation, stroke volume and ejection fraction were determined from simultaneous biplane views of left ventricle for 20 beats using a matrix-array transducer and a biplane Simpson's rule. The influence of cycle lengths on the values of systolic parameters at beats with equal subsequent cycles was examined from the plot of normalized parameters (measured values / average values) against cycle lengths. The values of 1 to 3 beats with equal subsequent cycles and cycle-length limits were averaged and compared with the average values over 20 beats by Bland-Altman and mean percentage difference analysis. The variability of repeat measurements was evaluated in 10 patients. Results: The systolic parameters measured at beats with cycle lengths shorter than 500 ms were usually far below the average values. Agreement and mean percentage difference analysis revealed improved accuracy when 2 or 3 beats with cycle-length limits (> 500 ms) were used for assessment. As the variability of averaging 2 or 3 beats is no greater than that of repeat measurements, both methods are equally good. Conclusions: Accurate assessment of left ventricular systolic function in atrial fibrillation can be obtained by averaging 2 beats with equal subsequent cycles and cycle-length limits (> 500 ms).