The highest single-cycle mean gradient during atrial fibrillation closely approximated sinus rhythm values (21 vs 20 mmHg; p=0.741), outperforming the standard 5-cycle average.
Observational (n=35)
Does using the highest single-cycle Doppler measurement improve agreement with sinus rhythm values compared to averaging 5 consecutive cycles in patients with aortic stenosis and atrial fibrillation?
Using the highest single-cycle Doppler gradient rather than the guideline-recommended 5-cycle average in patients with atrial fibrillation better approximates true aortic stenosis severity as measured in sinus rhythm.
Effect estimate: ICC 0.953
Absolute Event Rate: 21% vs 20%
p-value: p=0.741
The coexistence of atrial fibrillation (AF) and aortic stenosis (AS) complicates echocardiographic assessment, as AF-related beat-to-beat variability attenuates flow-dependent Doppler parameters like transvalvular Mean Gradient (MG) and Peak Velocity. Current guidelines recommend averaging these measurements over 5 consecutive cycles in AF; however, this may underestimate true AS severity. In this retrospective study of 35 patients with AS and preserved left ventricular ejection fraction (LVEF ≥50%) undergoing echocardiography in both AF and sinus rhythm (SR) within a 3-month interval, averaged MG during AF was significantly lower than SR (19 vs. 21 mmHg; p<0.001) with lower agreement (ICC=0.866), whereas the highest single-cycle MG closely approximated SR values (21 vs. 20 mmHg; p=0.741) with excellent agreement (ICC=0.953). A similar pattern was observed for peak velocity. These findings suggest that averaged AF gradients and velocities may underrecognize significant AS severity, and that the highest technically adequate AF values may better reflect true hemodynamic burden, warranting prospective validation.
Mahajan et al. (2026) conducted an observational in Aortic stenosis and atrial fibrillation (n=35). Highest single-cycle Mean Gradient (MG) during atrial fibrillation vs. Sinus rhythm (SR) measurements was evaluated on Mean Gradient (MG) (ICC 0.953, p=0.741). The highest single-cycle mean gradient during atrial fibrillation closely approximated sinus rhythm values (21 vs 20 mmHg; p=0.741), outperforming the standard 5-cycle average.