[Effect of atrial fibrillation on left ventricle function in the elderly]

Atrial fibrillation (FA) coexists with heart failure, and its occurrence frequency increases with age. This arrhythmia can precede heart failure as well as can be a consequence of cardiac function deterioration.

The influence of atrial fibrillation on left ventricle (LV) function assessed by echocardiography in the elderly. Investigated group. Study group consists of 30 older patients 75,9 (+/- 4,6) years old with chronic atrial fibrillation, mean duration 319,5 (+/- 292,5) days and 30 younger patients 56,7 (+/- 3,7) years old with atrial fibrillation, mean duration 254,2 (+/- 191,2) days. In control group were 30 persons 74,7 (+/- 5,1) years old with sinus rhythm (SR). In all patients transthoracic (TTE) echocardiography was performed to assess following parameters: end-diastolic diameter of LV (LVEDd), end-systolic diameter of LV (LVESd), fractional shortening of LV (FS LK), stroke volume of LV (SV LK), cardiac output (CO), ejection fraction of LV (EF LK), preejection period of LV (PEP LK), ejection period of LV (LVET), maximal aortic flow velocity (V max LK), maximal velocity of mitral early diastolic flow (E ampl LK), deceleration time of mitral early diastolic flow (E dcct LK). Consequently transoesophageal (TEE) echocardiography was made to record flow in left superior pulmonary vein (LSPV) and following parameters were measured: maximal systolic flow velocity in LSPV (PVS), maximal diastolic flow velocity in LSPV (PVD), integral of systolic flow in LSPV (PVS intg), deceleration time of diastolic flow in LSPV (PVD dcct). During Holter electrocardiographic recording were calculated: maximal heart rate (HR max), minimal heart rate (HR min), mean heart rate (Hr sr).

Older patients with atrial fibrillation characterised significantly lower EF LK and FS LK than younger patients and older patients with sinus rhythm. Most of Doppler echocardiographic parameters recorded from aortic flow as well as measured in left superior pulmonary vein have lower values in older patients with arrhythmia compared to younger ones. LVEDd was significantly greater in older patients with atrial fibrillation than in those with sinus rhythm. E ampl LK was markedly lower in older patients with atrial fibrillation and coexisted with shortening deceleration time of this flow in this group of patients. PVD did not differ in studied groups but deceleration time of this flow similarly to deceleration time of mitral flow was markedly shortened in older group of patients with arrhythmia. HR mean and Hr max in older patients with atrial fibrillation were significantly higher in older patients with atrial fibrillation compared to those without arrhythmia whereas HR min did not differ between mentioned groups. HR mean calculated from 24 hours correlated with poorer hemodynamic parameters of left ventricle.

Atrial fibrillation in the elderly causes greater systolic and diastolic dysfunction of left ventricle compared to younger patients with this kind of arrhythmia. The left ventricle contractility deterioration in older patients with atrial fibrillation correlates with high maximal and mean diurnal heart rate.