Augmentation of Pulmonary Vein Backflow Velocity during Left Atrial Contraction: A Novel Phenomenon Responsible for Progression of Atrial Fibrillation in Hypertensive Patients

Abstract

Background: Atrial fibrillation (AF) is a common arrhythmia showing disease progression. However, echocardiographic prediction of such progression remains incomplete. This study aimed to identify echocardiographic predictors of AF progression in hypertensive patients. Methods: Hypertensive patients with paroxysmal AF were divided into two groups: patients with AF which became permanent (group A; n = 13) and those with AF which remained paroxysmal (group B; n = 46) during the same follow-up period (8.0 ± 2.4 years). Clinical baselines showed no significant differences except for age. Transthoracic echocardiography was recorded 1–2 weeks after termination of the first-detected paroxysms of AF. Results: Echocardiography showed greater left atrial (LA) dimension (p = 0.023) and late diastolic pulmonary vein (PV) backflow velocity (p < 0.001), and a lower LA fractional shortening (p = 0.008) in group A than in group B. Multilogistic regression analysis demonstrated that augmented PV backflow (p = 0.007) and reduced LA fractional shortening (p = 0.032) were independent predictors of the progression of AF. The receiver-operating characteristic curve demonstrated that PV backflow augmentation is the best predictor of future AF perpetuation. Conclusion: PV backflow leading to cyclic stretching of PV musculature contributes to AF progression.

Pulmonary Venous Flow Pattern and Atrial Fibrillation: Fact and Controversy

“…5A), i.e., impaired sphincter function theoretically allows more PV regurgitation and Ar wave augmentation. Surprisingly, increased Ar amplitude is associated with reduced, but not increased, LA contractility in our study (Maruyama et al, 2008). These findings imply that PV sphincter dysfunction is linked to the contractile LA remodeling responsible for AF progression.…”

Anticoagulation Stability Depends on CHADS₂ Score and Hepatorenal Function in Warfarin-treated Patients, Including Those with Atrial Fibrillation

“…Adherence of warfarin among three groups had to be compared under the different optimal INR range although the width of INR range was set equally at 1.0 among the three groups (i.e., 1.5–2.5 for patients with CTEPH, 1.6–2.6 for aged patients with AF (≥75 years), and 2.0–3.0 for the other patients with AF or those with HVR). CHADS 2 components except for hypertension and senescence were found to be factors affecting TTR in the AF group ( Table 2 ), indicating bias of hypertensive elderly accumulated in this group although these findings imply that hypertensive patients are prone to develop AF 31) . Second, pharmacogenomics of warfarin metabolism such as VKORC1 and CYP2C9 polymorphisms were not considered.…”

Relationship between amiodarone-induced subclinical lung toxicity and Th1/Th2 balance

“…Such toxicity as defined in this study has never been encountered in our patients with atrial fibrillation treated with antiarrhythmic drugs other than amiodarone [22]. Therefore, lung toxicity observed in this study is considered to be due to amiodarone per se.…”