scholarly journals Effect of beta-blocker-induced heart rate lowering on left atrial function in patients with hypertension and recurrent atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Kokhan ◽  
G Kiyakbaev ◽  
E Ozova ◽  
V Romanova ◽  
Z.H Kobalava
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Left Atrial ◽  
Prospective Trial ◽  
Study Groups ◽  
Adverse Outcomes ◽  
Final Visit ◽  
Left Ventricle Mass ◽  
Recurrent Atrial Fibrillation ◽  
Median Change

Abstract Background The ESC/ESH Hypertension Guidelines identify high resting heart rate (HR) as a risk factor in patients with hypertension. However, it is not known, whether pharmacological reduction in HR is associated with improvement of prognosis in patients with preserved ejection fraction. In retrospective studies beta blockers (BBs) use was associated with impaired left atrial (LA) function in hypertension, but the prospective data, concerning this relationship is scarce. Purpose To assess the effects of HR reduction with BBs on LA function in hypertensive patients with recurrent (rare paroxysms) mild symptomatic atrial fibrillation. Methods Open prospective trial included 91 patients with hypertension, elevated heart rate (≥80 bpm) and recurrent atrial fibrillation (EHRA 2A or less) with rare paroxysms to receive BBs with a target HR (sinus rhythm) of less or greater than 70 bpm. All the patients underwent an echocardiogram at baseline and at the end of the study. Conventional echo measures and extended LA measures, including the minimal and maximal LA volumes (LAVmin and LAVmax) and LA emptying fraction (LAEF) were performed. Patients were followed for 4 months on the change and assessed for primary endpoint of median LAEF measurement at the end of the study. Results 47 patients were randomized to group with a target HR of ≤70 bpm and 44 patients to >70 bmp. Among them, 44 and 41 patients completed the study (2 had AF at the final visit; 4 were lost to follow-up). Baseline median HR was 77 (75; 80) bpm. After 4.4 months of treatment, median HR was 62 (60; 67) bmp in ≤70 group and 73 (72; 76) bpm in >70 group (p<0.001). There were no intergroup differences in antihypertensive therapy and systolic (129 vs 130 mmHg; p=0.32) and diastolic (78 vs 78 mmHg; p=0.53) blood pressure. At the end of the study patients in ≤70 group had significantly lower LAEF compared with >70 group (37 vs 42%; p=0.01); a median change was −6.5 (−9.75; −3.9)% and −0.27 (−1.78; 1.18)%, respectively [estimated between group difference −5.89%; 95% confidence interval (CI): −8.06 to −3.71%]. Despite similar indices of LAVmin (22 vs 19 ml/m2; p=0.66) and LAVmax (38 vs 37 ml/m2), comparison of changes showed significant differences: median change LAVmin: 1.3 ml/m2 in ≤70 vs 0.5 ml/m2 in >70 groups (estimated between group difference −1.29%; 95% CI: −2.07 to −0.5%) and ΔLAVmax: 1.8 ml/m2 in ≤70 vs 1 ml/m2 in >70 groups (estimated between group difference −1.51%; 95% CI: −2.73 to −0.28%). E/E' and left ventricle mass index did not differ between study groups at the end of the study, but E' was significantly lower in the ≤70 group (7 vs 8.3 cm/s; p=0.04). Conclusion BB-induced HR lowering with a target ≤70 bpm significantly reduced LA function as compared to lenient target HR (>70 bpm). Although elevated HR is associated with adverse outcomes in patients with hypertension, excess HR lowering with BBs might not be beneficial in this group. Funding Acknowledgement Type of funding source: None

scholarly journals Left Atrial Function in Different Modes of Heart-Rate Lowering Therapy with Beta-Blockers in Patients with Recurrent Atrial Fibrillation and Hypertension

2021 ◽  
Vol 17 (3) ◽  
pp. 429-437
Author(s):  
E. V. Kokhan ◽  
G. K. Kiyakbaev ◽  
E. M. Ozova ◽  
V. A. Romanova ◽  
Zh. D. Kobalava
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Left Atrial ◽  
Augmentation Index ◽  
Beta Blockers ◽  
Prospective Trial ◽  
Applanation Tonometry ◽  
Recurrent Atrial Fibrillation ◽  
The Impact

Aim. To study the impact of heart rate (HR) reduction with beta-blockers (BB) on left atrial (LA) function in hypertensive patients with paroxysmal or persistent mild symptomatic atrial fibrillation.Material and methods. In this open prospective trial we randomly assigned patients with hypertension, sinus rhythm, elevated heart rate (≥70 bpm), and recurrent atrial fibrillation (EHRA 2A or less) to receive BB with a target HR of less or greater than 70 bpm for at least 4 months. All the patients underwent an echocardiogram [left atrial (LA) function was assessed as emptying fraction]and applanation tonometry at baseline and after 4 months. Primary endpoint was median LA emptying fraction (LAEF) measurement at the end of the study.Results. 47 patients were randomized to group with a target HR of ≤70 bpm and 44 patients to >70 bmp. Among them 44 and 41 patients completed the study. Median follow up was 4.4 months. At the end of the study (4.5 months) median HR was 62 [60; 67] bmp in ≤70 group and 73 [72; 76] bpm in >70 group. Both groups received similar antihypertensive therapy and there were no intergroup differences in systolic and diastolic blood pressure. At the end of the study, patients in ≤70 group had significantly lower LAEF compared with >70 group (37% vs 42%; p=0.01). E’avg was lower and augmentation index was higher in ≤70 group as compared to >70. In regression analysis, after E’avg and augmentation index were included in the model, the association between LAEF and randomization group lost its significance.Conclusion. Beta blockers treatment with strict HR reduction (≤70 bpm) significantly reduced LA function as compared to lenient target HR (>70 bpm).

scholarly journals Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Marco Spartera ◽  
Guilherme Pessoa-Amorim ◽  
Antonio Stracquadanio ◽  
Adam Von Ende ◽  
Alison Fletcher ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Peak Velocity ◽  
4D Flow ◽  
Mean Velocity

Abstract Background Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows sophisticated quantification of left atrial (LA) blood flow, and could yield novel biomarkers of propensity for intra-cardiac thrombus formation and embolic stroke. As reproducibility is critically important to diagnostic performance, we systematically investigated technical and temporal variation of LA 4D flow in atrial fibrillation (AF) and sinus rhythm (SR). Methods Eighty-six subjects (SR, n = 64; AF, n = 22) with wide-ranging stroke risk (CHA2DS2VASc 0–6) underwent LA 4D flow assessment of peak and mean velocity, vorticity, vortex volume, and stasis. Eighty-five (99%) underwent a second acquisition within the same session, and 74 (86%) also returned at 30 (27–35) days for an interval scan. We assessed variability attributable to manual contouring (intra- and inter-observer), and subject repositioning and reacquisition of data, both within the same session (same-day scan–rescan), and over time (interval scan). Within-subject coefficients of variation (CV) and bootstrapped 95% CIs were calculated and compared. Results Same-day scan–rescan CVs were 6% for peak velocity, 5% for mean velocity, 7% for vorticity, 9% for vortex volume, and 10% for stasis, and were similar between SR and AF subjects (all p > 0.05). Interval-scan variability was similar to same-day scan–rescan variability for peak velocity, vorticity, and vortex volume (all p > 0.05), and higher for stasis and mean velocity (interval scan CVs of 14% and 8%, respectively, both p < 0.05). Longitudinal changes in heart rate and blood pressure at the interval scan in the same subjects were associated with significantly higher variability for LA stasis (p = 0.024), but not for the remaining flow parameters (all p > 0.05). SR subjects showed significantly greater interval-scan variability than AF patients for mean velocity, vortex volume, and stasis (all p < 0.05), but not peak velocity or vorticity (both p > 0.05). Conclusions LA peak velocity and vorticity are the most reproducible and temporally stable novel LA 4D flow biomarkers, and are robust to changes in heart rate, blood pressure, and differences in heart rhythm.

scholarly journals B-PO04-077 HEART RATE VARIABILITY AND LEFT ATRIAL HEMODYNAMICS IN ATRIAL FIBRILLATION MEASURED WITH 4D FLOW MRI

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S310
Author(s):  
Amanda DiCarlo ◽  
Justin Baraboo ◽  
Mitchell A. Collins ◽  
Maurice Pradella ◽  
Patrick M. McCarthy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Left Atrial ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

scholarly journals P814 Independent association of body mass index and left atrial strain in patients with non valvular atrial fibrillation. The NeAfib-Echo registry

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Esposito ◽  
R Sorrentino ◽  
V Capone ◽  
C Santoro ◽  
M Lembo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Heart Rate ◽  
Body Mass ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Overweight And Obesity ◽  
Volume Index ◽  
The Third ◽  
Lv Mass

Abstract Background Overweight and obesity are related to the risk of new-onset atrial fibrillation (AF). Peak atrial longitudinal strain (PALS) is an advanced echocardiographic parameter of left atrial (LA) function with a recognized diagnostic and prognostic role in both the general population and AF. Purpose To investigate the impact of body mass index (BMI) on LA function by utilizing standard and advanced echocardiography in patients with non-valvular AF. Methods In the NeAfib-Echo registry, 395 consecutive adult patients with non-valvular AF (F/M: 175/220; mean age 70.6 ± 11 years, BMI: 27.8 ± 5.6 kg/m²) were enrolled. 215 patients (54.1%) had permanent/persistent AF (prAF) and 178 (45.9%) had paroxysmal AF (pxAF). Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc score was calculated. Patients underwent a complete echo-Doppler exam, including determination of PALS and left ventricular (LV) global longitudinal strain (GLS) (both reported in absolute values). The overall population was divided according to BMI tertiles: first tertile &lt;25.3 Kg/m² (n = 127); second tertile 25.3-29 Kg/m² (n = 137); third tertile &gt; 29.3 Kg/m² (n = 130). Results No significant difference of sex prevalence, age, systolic BP and heart rate was found among the three BMI tertiles, whereas diastolic BP was higher in the third tertile (p &lt; 0.001). CHA2DS2VASc score did not significantly differ among tertiles. In the pooled population LV mass index (LVMi) (p = 0.001) progressively increased from the first to the third tertile (p &lt; 0.001), whereas LA volume index, LV ejection fraction (EF), GLS and E/e" ratio were not significantly different among the three groups. PALS was lower in third tertile (14.3 ± 8.2%) versus both the first (19.0 ± 11.5%) and the second tertile (17.7 ± 10.6%) (p &lt; 0.002). In separate sub-analyses according to AF type, PALS was significantly lower in the first than the third tertile in the PxAF group (p &lt; 0.01) but not in patients with PrAF (p = 0.158). In the pooled population PALS was significantly related with BMI (r= -0.17, p &lt; 0.001) (Figure) but also with age, heart rate, LVMi, LV EF, GLS, E/e’ ratio and pulmonary artery systolic pressure (PAPS). By a multilinear regression analysis, after adjusting for CHA2DS2VASc score, LV mass index, LV EF, E/e’ ratio and PAPs, BMI remained independently associated with PALS (standardized β coefficient = -0.127, p &lt; 0.02) (cumulative R² =0.41, SEE = 8.5%, p &lt; 0.0001). Conclusions In patients with non valvular AF, overweight and obesity exert a detrimental effect on LA function as testified by the gradual PALS reduction with the increase of BMI tertiles. BMI is associated with PALS independently of several confounders including CHA2DS2VASc. Besides CHA2DS2VASc score, BMI could be considered as an additional factor for evaluating cardiovascular risk in non valvular AF. Abstract P814 Figure. Relation between BMI and PALS

Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

2021 ◽  
pp. 021849232110421
Author(s):  
Michael Seco ◽  
Jonathan CL Lau ◽  
Caroline Medi ◽  
Paul G Bannon
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Atrial Tachyarrhythmias ◽  
Left Atrial Diameter ◽  
Septal Myectomy ◽  
Concomitant Surgery ◽  
Recurrent Atrial Fibrillation

Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

scholarly journals Left Atrial Remodeling and Response to Valsartan in the Prevention of Recurrent Atrial Fibrillation

2011 ◽  
Vol 4 (6) ◽  
pp. 721-728 ◽  
Author(s):  
Lidia Staszewsky ◽  
Maylene Wong ◽  
Serge Masson ◽  
Elena Raimondi ◽  
Silvana Gramenzi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Remodeling ◽  
Left Atrial Remodeling ◽  
Recurrent Atrial Fibrillation

scholarly journals Predictors of Failure Cardioversion for Recurrent Atrial Fibrillation Following Mitral Valve Surgery With Ablation

2020 ◽  
Vol 23 (3) ◽  
pp. E300-E304
Author(s):  
Hailong Cao ◽  
Xin Chen ◽  
Xiyu Zhu ◽  
Yining Yang ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Mitral Valve ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Loading Dose ◽  
Left Atrial Diameter ◽  
Recurrent Atrial Fibrillation

Background: Electrical cardioversion (ECV) often is required for terminating recurrent atrial fibrillation (AF) after surgical radiofrequency ablation in patients undergoing mitral valve surgery. However, ECV is unsuccessful in some cases. In this study, we aimed to identify possible predictors of failed ECV for recurrent atrial fibrillation following mitral valve surgery with concomitant radiofrequency ablation. Methods: We enrolled 1,136 persistent AF patients with history of mitral valve surgery and concomitant radiofrequency ablation. Three-hundred-nineteen patients experienced recurrence of persistent AF and received ECV therapy. Comparison was made between patients with failed ECV (Failure group, N = 68) and successful ECV (Success group, N = 251). Results: In multivariate regression analysis, age, pre-ECV loading-dose amiodarone, left atrial diameter, atrial flutter and time from surgery to ECV were independent predictors for outcomes of ECV. According to receiver operating characteristic curve analysis, the best threshold values of age, left atrial diameter and time from surgery to ECV for predicting failed ECV were 55.5 years, 64.5 mm, and 90.5 days, respectively. Conclusion: Older age, larger left atrium and longer time from surgery to ECV are independent predictors for failed ECV in this group. Compared with AF, atrial flutter is easier to be successfully terminated by ECV. Pre-ECV loading-dose amiodarone is helpful for successful ECV. These findings have important implications for identifying the kinds of patients to receive effective ECV.

scholarly journals Left atrial dissection as a trigger for recurrent atrial fibrillation

2020 ◽  
Vol 6 (6) ◽  
pp. 329-333
Author(s):  
Anthony H. Kashou ◽  
Christopher V. DeSimone ◽  
Samuel J. Asirvatham ◽  
Suraj Kapa
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Recurrent Atrial Fibrillation ◽  
Left Atrial Dissection
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