The Sonographer Attachment Programme At USA Report : Mayo Clinic: Sonographer Experience =LA Atrial Mechanical Function=

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%