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Effect of rhythm regularization on left ventricular contractility in patients with atrial fibrillation

      Clinical and experimental data support the notion that atrial fibrillation (AF) with persistent tachycardia can have a negative impact on left ventricular (LV) function, and that rate control may reverse tachycardia-mediated ventricular dysfunction.
      • Phillips E
      • Levine S.A
      Auricular fibrillation without other evidence of heart disease a cause of reversible heart failure.
      ,
      • Grogan M
      • Smith H.C
      • Gersh B.J
      • Wood D.L
      Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy.
      ,
      • Schumacher B
      • Luderitz B
      Rate issues in atrial fibrillation consequences of tachycardia and rate control.
      The independent effect of rhythm regularization also appears to have a beneficial hemodynamic effect, such that, at equal heart rates, cardiac output appears to be higher when the ventricular rhythm is regular.
      • Schumacher B
      • Luderitz B
      Rate issues in atrial fibrillation consequences of tachycardia and rate control.
      ,
      • Daoud E.G
      • Weiss R
      • Bahu M
      • Knight B.P
      • Bogun F
      • Goyal R
      • Harvey M
      • Strickberger S.A
      • Mann K.C
      • Morady F
      Effect of an irregular rhythm on cardiac output.
      ,
      • Clark D.M
      • Plumb V.J
      • Epstein A.E
      • Kay G.N
      Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation.
      However, whether an irregular rhythm, per se, has a negative effect on LV intrinsic contractility is unknown. Accordingly, we designed the present study to assess contractility in patients with AF before and immediately after direct-current cardioversion. By performing the studies immediately after cardioversion, we were able to obtain data before the return of an effective atrial contraction, thereby excluding the beneficial hemodynamic effect of atrial systole. In addition, comparisons (before and after cardioversion) were made at equal preceding RR intervals, so as to limit differences in LV preload. Thus, we tested the hypothesis that rhythm regularization is associated with a higher LV contractile state than is seen when rhythm is irregular.
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