Pulmonary Venous Flow Pattern and Atrial Fibrillation: Fact and Controversy

Maruyama, Toru; Kokawa, Yousuke; Nakamura, Hisataka; Fukata, Mitsuhiro; Yasuda, Shin; Odashiro, Keita; Akashi, Koichi

doi:10.5772/30435

Cited by 2 publications

(2 citation statements)

References 45 publications

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“…Previous retrospective studies have identified atrial fibrillation (AF) and left atrial (LA) dilation as predictors of increased mortality among dMR patients, both conservatively managed [ 2 , 3 ] and surgically treated [ 3 , 4 ]. Serving as the mechanistic link between MR and atrial aberrations [ 5 , 6 ] is LA remodeling, the manifestations of which may include abnormal pulmonary venous (PV) flow pattern (PVFP). Already considered to be supportive evidence of severe MR [ 7 ], a reversed PVFP likely signifies a worse disease state which may adversely affect prognosis.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

Shechter

Butcher

Siegel

et al. 2023

JCDD

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Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. Results: Overall, 135 patients (median age 68 (IQR, 58–74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0–155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21–5.31, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, p = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR.

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Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

Shechter

Butcher

Siegel

et al. 2023

JCDD

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“…FIGURE 1: Atrial fibrillation pathophysiology AF: Atrial fibrillation Data from the study by Maruyama et al, (2012)[8] …”

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confidence: 99%

Effectiveness of Catheter Ablation in Left Ventricular Ejection Fraction, Stroke, Quality of Life, All-Cause Mortality, Sinus Rhythm Maintenance, and Hospitalization Rates as Compared to Medical Therapy

Oble,

Sonia,

George

et al. 2023

Cureus

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Atrial fibrillation (AF) in the setting of heart failure (HF) accounts for a significant proportion of mortality. AF can be managed either with rate control or rhythm control strategies. Rate control involves the use of beta blockers or calcium channel blockers. Rhythm control methods use antiarrhythmic drugs or catheter ablation (CA) to abolish the rhythm. Articles from PubMed and Google Scholar were chosen for review. The literature was reviewed for data from the last 10 years to be chosen for interpretation. Clinical trials, meta-analyses, and systematic analysis were included in this study. Various health parameters such as all-cause mortality, hospitalization rates, sinus rhythm (SR) maintenance, quality of life improvement, stroke risk, left ventricular ejection fraction (LVEF) improvement, and healthcare costs were analyzed. We demonstrated that CA was superior to medical therapy in reducing all-cause mortality and hospitalization. It leads to significant improvement in LVEF as SR was maintained consistently. Overall, quality of life improved in those who underwent ablation as compared to those who did not. Stroke risk reduction was seen in observational studies only. We recommend CA as first-line therapy for treating patients with AF in the setting of HF. More clinical trials are needed to determine the effectiveness of ablation in reducing stroke risk.

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Pulmonary Venous Flow Pattern and Atrial Fibrillation: Fact and Controversy

Cited by 2 publications

References 45 publications

The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

Effectiveness of Catheter Ablation in Left Ventricular Ejection Fraction, Stroke, Quality of Life, All-Cause Mortality, Sinus Rhythm Maintenance, and Hospitalization Rates as Compared to Medical Therapy

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