Atrial Fibrillation Complicated by Heart Failure: First the Chicken or First the Egg?
KeywordsAtrial Fibrillation Ventricular Dysfunction Chronic Atrial Fibrillation Ventricular Response Atrial Mechanical Function
The hemodynamic consequences of atrial fibrillation (AF) are related to loss of atrial contribution to cardiac output, increase in heart rate, with shortening in the duration of diastole, and irregularity in diastolic intervals. The loss of atrial contribution to ventricular filling may be well tolerated in a healthy heart but may have adverse consequences in the presence of left ventricular dysfunction. Loss of atrial transport is particularly significant if there is impairment in left ventricular filling due to reduced diastolic compliance or mitral stenosis. Moreover, in patients of this kind, a high or irregular heart rate with frequent short diastolic intervals will be poorly tolerated. In the long term, sustained, uncontrolled tachycardia with a heart rate higher than 120 beats/min leads to impairment of left ventricular function with various degrees of ventricular dysfunction, which may result in significant worsening of the patient’s clinical condition unless the heart rate can be controlled or sinus rhythm restored. This clinical condition has been called “tachycardiomyopathy” or “tachycardia-induced cardiomyopathy” [1–6].
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