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

Vol. 109, No. 1, 2008

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Original Research

Augmentation of Pulmonary Vein Backflow Velocity during Left Atrial Contraction: A Novel Phenomenon Responsible for Progression of Atrial Fibrillation in Hypertensive Patients
Toru Maruyama^a, Toshisuke Kishikawa^a, Hiroyuki Ito^a, Yoshikazu Kaji^a, Yasushi Sasaki^b, Yasushi Ishihara^c

^aDepartment of Medicine, Kyushu University,
^bFukuoka Wajiro Hospital and
^cIshihara Cardiovascular Hospital, Fukuoka, Japan

Address of Corresponding Author

Cardiology 2008;109:33-40 (DOI: 10.1159/000105324)

Key Words

Atrial fibrillation
Echocardiography
Hypertension
Pulmonary vein

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.

Author Contacts

Toru Maruyama, MD
Department of Medicine, Kyushu University
Fukuoka 812-8582 (Japan)
Tel. +81 92 642 5235, Fax +81 92 642 5247
E-Mail maruyama@ihs.kyushu-u.ac.jp

Article Information

Received: July 14, 2006
Accepted after revision: October 26, 2006
Published online: July 10, 2007
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 2, Number of References : 30

Medline Abstract (ID 17627107)

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