Left atrial remodeling and ventricular-arterial coupling in patients with atrial fibrillation: effects of amiodarone and sotalol

Aim

To compare the effects of amiodarone and sotalol on echocardiographic parameters in patients with recurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) and to evaluate the predictive value of echocardiographic and ventricular-arterial coupling (VAC) parameters for recurrence of AF.

Material and methods

Sixty patients (45% male, mean age of 65 [61; 72] years) with recurrent AF, HFpEF (NYHA I-II) and stable coronary artery disease (CAD) were enrolled in the open randomized trial and were treated with amiodarone (A) 200 mg + metoprolol 50 mg daily (n=30) or sotalol (S) 160 mg daily (n=30). Baseline clinical characteristics and concomitant therapy were comparable in the two groups. Echo cardio graphy was performed at baseline and after 3 months.

Results

Left atrial (LA) size, left ventricular (LV) global longitudinal strain and diastolic function improved significantly in the A group. However, LA global strain rate (GSR) during LA filling increased more significantly in the S group. All other parameters changed similarly in the both groups. EaI was inversely correlated with LA size, end-diastolic volume (EDV) and LA global strain during the contractile phase. Тotal arterial compliance was inversely correlated with AF duration and AF recurrences within 3 months. According to stepwise multiple regression analysis LA GSR during the contractile phase was the only independent parameter associated with the efficacy of antiarrhythmic therapy (β=0.38, р=0.04).

Conclusion

A and S had comparable antiarrhythmic effect, but A improved LA size, LV global longitudinal strain and diastolic function more significantly than S in patients with recurrent AF, HFpEF and stable CAD.

Key words

Atrial fibrillation, heart failure, ventriculararterial coupling, left atrium dysfunction.