Augmentation of pulmonary vein backflow velocity during left atrial contraction: a novel phenomenon responsible for progression of atrial fibrillation in hypertensive patients.
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.


CONCLUSIONS
PV backflow leading to cyclic stretching of PV musculature contributes to AF progression.
Maruyama
Toru
T
Department of Medicine, Kyushu University, Fukuoka, Japan. maruyama@ihs.kyushu-u.ac.jp
Kishikawa
Toshisuke
T
Ito
Hiroyuki
H
Kaji
Yoshikazu
Y
Sasaki
Yasushi
Y
Ishihara
Yasushi
Y
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*