ABSTRACT
Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, pâ¯=â¯0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, pâ¯=â¯0.003). This effect was only seen in male patients (27.5% vs 5.8%, pâ¯=â¯0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, pâ¯=â¯0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women.
Subject(s)
Atrial Fibrillation/epidemiology , Blood Pressure/physiology , Heart Rate/physiology , Hypertension/epidemiology , Hypertrophy, Left Ventricular/epidemiology , Population Surveillance , Age Distribution , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Comorbidity , Disease Progression , Echocardiography , Electrocardiography, Ambulatory , Europe/epidemiology , Female , Follow-Up Studies , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Incidence , Male , Middle Aged , Prognosis , Registries , Retrospective Studies , Risk Factors , Sex Distribution , Survival Rate/trendsABSTRACT
AIMS: To investigate the clinical characteristics, management, and outcome of patients with paroxysmal atrial fibrillation (AF) associated with autonomic triggers. METHODS AND RESULTS: One thousand five hundred and seventeen patients with paroxysmal AF participated in the Euro Heart Survey on AF. We categorized patients according to trigger pattern as reported by the physician: adrenergic (AF associated with exercise, emotion or during daytime only and absence of vagal triggers), vagal (postprandial or night time only, without presence of adrenergic triggers) and mixed (combination of vagal and adrenergic triggers). Vagal AF was found in 91 patients (6%), adrenergic in 229 patients (15%) and mixed in 175 (12%) patients. Underlying heart disease was equally prevalent in the three groups. Among patients with vagal AF, 73% were treated with non-recommended drugs according to the guidelines. In vagal AF, non-recommended treatment was associated with a shift to persistent or permanent AF in 19% of the patients, compared with none in the group receiving recommended treatment (P = 0.06). CONCLUSION: This study is the first to address the issue of autonomic trigger patterns and AF in a large population. Autonomic trigger patterns were seen frequently in paroxysmal AF patients. Autonomic influences should be taken into consideration since non-recommended treatment may result in aggravation of vagal AF.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Tachycardia, Paroxysmal/drug therapy , Atrial Fibrillation/etiology , Autonomic Nervous System Diseases/complications , Female , Guideline Adherence/standards , Health Surveys , Humans , Male , Middle Aged , Practice Guidelines as Topic/standards , Tachycardia, Paroxysmal/etiologyABSTRACT
BACKGROUND: Gated blood pool tomoscintigraphy has the unique capacity to accurately assess myocardial motion in paced patients. Our goal was to develop a precise radionuclide angiography analysis of cardiac dynamics to evaluate ventricular synchronization in patients undergoing biventricular pacing. METHODS AND RESULTS: On the basis of a 4-dimensional deformable motion estimation algorithm, we developed a protocol allowing estimation of motion fields after gated blood pool tomoscintigraphy. We measured the mechanical activation times for 17 left ventricular (LV) segments and determined the main types of contraction pattern in 10 normal subjects, 17 patients with dilated cardiomyopathy, and 12 resynchronized patients. We analyzed intra-LV dyssynchrony: apex to base, septum to lateral wall, and anterior wall to inferior wall. Three-dimensional measurements of intra-LV activation time (r > .80, P < .001) and LV ejection fraction (r > 0.90, P < .0001) are linearly correlated to 2-dimensional values. LV contraction follows the electrical activation pattern. In normal subjects the anteroseptal and anterior segments are first activated, followed by the apex and inferolateral segments. In resynchronized patients contraction begins with the lateral and apicoseptal segments in correspondence to the LV and right ventricular lead implantation. CONCLUSIONS: By measuring mechanical activation times, this technique allows for the analysis of the regional synchronous contraction. This may help to assess the variation of the activation pattern according to the cardiomyopathy type and the role of septal resynchronization in ventricular functional recovery.
