Changes in Left Ventricular Filling in Patients with Persistent Atrial Fibrillation

Abstract

BACKGROUND: Former studies showed possible interrelationship between altered ventricular filling patterns and atrial fibrillation (AF).HYPOTHESIS: Long term persistent AF has a negative impact on left ventricular filling in patients with preserved ejection fraction of left ventricle.METHODS: Our study was designed as a prospective case control study. We included 40 patients with persistent AF and preserved ejection fraction after successful electrical cardioversion and 43 control patients. Persistent AF was defined as AF lasting more than 4 weeks. Cardiac ultrasound was performed in all patients 24 hours after the procedure. Appropriate mitral flow and tissue Doppler velocities as well as standard echocardiographic measurements were obtained.RESULTS: There were no significant differences between both groups' parameters regarding age, sex, commorbidities or drug therapy. Analysis of mitral flow velocities showed significant increase of E value in AF group (0.96±0.27 vs.0.70±0.14; p = 0.001). Tissue Doppler measurements didn't reveal any differences in early diastolic movement, however there was a statistically significant difference in E/Em values of both groups, respectively (12.0±4.0 vs. 9.0±2.1; p= 0.001).CONCLUSION: Our study shows that in patients with preserved systolic function and persistent AF shortly after cardioversion diastolic ventricular filling patterns are altered mainly due to increased left atrial pressure and not due to impaired diastolic relaxation of left ventricle. Further studies are needed in order to define the interplay between diminished atrial function and impaired ventricular filling.

Longitudinal analysis of echocardiographic and cardiac biomarker variables in dogs with atrial fibrillation: The optimal rate control in dogs with atrial fibrillation II study

“…This finding may be explained by the fact that in the presence of impaired LV relaxation, which is often a consequence of chronic AF, 38 increased LA pressures can falsely “normalize” the IVRT 39 . In our study, IVRT increased after the addition of AAD and was significantly longer at V2 in RC dogs, compared with NRC dogs, lending further support to the concept that filling pressures are decreased directly by lowering HR, in addition to the known benefits of longer diastole on ventricular relaxation 40 …”

Mutational Spectrum of the NKX2-5 Gene in Patients with Lone Atrial Fibrillation

“…The annual incidence of stroke attributable to AF also increases with age, ranging from 1.5% of people in their fifties to 23.5% in octogenarians 4 , 5 . In addition, AF may contribute to degraded quality of life, reduced exercise tolerance, impaired cognitive function, tachycardia-induced cardiomyopathy, and left ventricular dysfunction or even congestive heart failure 1 , 6 . AF commonly occurs in association with various cardiac and systemic conditions, such as coronary artery disease, congenital heart disease, rheumatic heart disease, cardiac surgery, cardiomyopathy, myocarditis, pulmonary heart disease, hypertension, hyperthyroidism, and even electrolyte imbalance 1 , 7 - 9 .…”

Correlation between Atrial Fibrillation and Heart Failure with Preserved Ejection Fraction: A Review

“…Moreover, AF can have detrimental effects on the LV function, such as the loss of atrial contractions, irregular ventricular filling, and irregular or high ventricular rate. However, most of these mechanisms usually occur during the acute onset of atrial tachyarrhythmia [41]. This was also demonstrated in a recent study that evaluated the relationship between longitudinal LV peak strain and preceding RR-interval in 10 patients with persistent AF.…”