Effect of atrial fibrillation on pulmonary venous flow patterns: transoesophageal pulsed Doppler echocardiographic study

Abstract

The effect of atrial fibrillation on pulmonary venous flow patterns is still not well known. Twenty-four patients in atrial fibrillation and 21 patients in sinus rhythm were studied by transoesophageal echocardiography. In ninety-five percent (20/21) of sinus rhythm patients, the early systolic wave due to atrial relaxation or reverse wave due to atrial contraction could be distinguished on pulsed Doppler tracings by transoesophageal echocardiography. However, there was no early systolic wave and/or reverse at the end of diastole in any atrial fibrillation patients. In atrial fibrillation patients without mitral regurgitation (n = 14), the onset of systolic flow was delayed (165 +/- 38 vs 50 +/- 46 ms, P < 0.05), and systolic peak velocities, time-velocity integrals and systolic fractions were reduced (31 +/- 13 vs 54 +/- 17 cm.s-1, P < 0.05; 5 +/- 2 vs 13 +/- 6 cm, P < 0.05 and 36 +/- 8 vs 61 +/- 15%, P < 0.05, respectively) as compared to those in sinus rhythm. Significant mitral regurgitation (n = 10) reduced systolic velocity parameters considerably in atrial fibrillation patients but the diastolic flow parameters were not significantly different between sinus rhythm and atrial fibrillation patients. Stepwise multiple regression analysis identified atrial fibrillation as an important independent predictor for changes in systolic flow parameters. The R-R interval is also an important factor for diastolic flow parameters. Thus, the present study demonstrates that atrial fibrillation significantly modifies pulmonary venous flow pattern and is an important factor for systolic flow parameters. Significant mitral regurgitation can further modify systolic flow pattern in atrial fibrillation patients.

Pulmonary Venous Flow Assessed by Doppler Echocardiography in the Management of Atrial Fibrillation

“…In contrast to systolic PVF, the diastolic PVF shows no relation to LAA dysfunction or SEC formation 11 . This observation is supported by findings from others, 5,7 who showed similar diastolic PVF parameters for patients in sinus rhythm and AF.…”

Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast

“…This observation is supported by ndings from Ren et al, who showed similar diastolic PVF parameters for patients in sinus rhythm and AF. 8 There seems to be a close relation between SEC and intraatrial thrombus formation. 3-5 , 24 Because 36% of our patients received anticoagulant medication, and thrombus resolution using warfarin as previously described, 28,29 the same prevalence of thrombus formation in patients with and without SEC does not indicate con icting data.…”

“…The systolic fraction of PVF was calculated as systolic VTI divided by the sum of the systolic and diastolic VTI. 8 The presence of SEC was diagnosed by the presence of dynamic swirling, smoke-like echos within the left atrium and the LAA using normal gain settings. 12 Representative transthoracic images, LAA images, and LAA and PVF Doppler ow signals were digitized, stored on optical disks, and analyzed off line with custom-made software.…”

“…AF also has been shown to modify pulmonary venous ow (PVF). 7,8 Systolic PVF re ects left atrial function, mainly atrial relaxation. 9 Similarly, a possible relation between PVF parameters and SEC also has not been reported.…”

Correlation between N-Terminal Pro-Brain Natriuretic Peptide and Doppler Echocardiographic Parameters of Left Ventricular Filling Pressure in Atrial Fibrillation

“…A reduction in systolic pulmonary venous blood flow expressed by reduced peak velocity, velocity time integral of systolic flow, and systolic fraction of pulmonary venous blood flow was found to be attributable to AF 14). Those patterns of pulmonary venous blood flow changes are related with LA dysfunction, mainly in atrial relaxation, compliance, and reservoir function 15).…”