Changes in Left Ventricular Filling in Patients with Persistent Atrial Fibrillation

BACKGROUND Former studies showed possible interrelationship between altered ventricular filling patterns and atrial fibrillation (AF). HYPOTHESIS Long term persistent AF has a negative impact on left ventricular filling in patients with preserved ejection fraction of left ventricle. METHODS Our study was designed as a prospective case control study. We included 40 patients with persistent AF and preserved ejection fraction after successful electrical cardioversion and 43 control patients. Persistent AF was defined as AF lasting more than 4 weeks. Cardiac ultrasound was performed in all patients 24 hours after the procedure. Appropriate mitral flow and tissue Doppler velocities as well as standard echocardiographic measurements were obtained. RESULTS There were no significant differences between both groups' parameters regarding age, sex, commorbidities or drug therapy. Analysis of mitral flow velocities showed significant increase of E value in AF group (0.96±0.27 vs.0.70±0.14; p = 0.001). Tissue Doppler measurements didn't reveal any differences in early diastolic movement, however there was a statistically significant difference in E/Em values of both groups, respectively (12.0±4.0 vs. 9.0±2.1; p= 0.001). CONCLUSION Our study shows that in patients with preserved systolic function and persistent AF shortly after cardioversion diastolic ventricular filling patterns are altered mainly due to increased left atrial pressure and not due to impaired diastolic relaxation of left ventricle. Further studies are needed in order to define the interplay between diminished atrial function and impaired ventricular filling.