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Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex inter-relationship

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Abstract

Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and their co-presence is associated with adverse outcomes relating to thromboembolic events, HF progression, hospitalisation and death. Diastolic dysfunction (DD) is also frequently present in patients with HF and is an independent predictor of hospitalisation and mortality. The presence of DD is a strong predictor of incident AF in patients with HF. In this review, we provide mechanistic insight into pathophysiological processes that frequently promote the occurrence of AF, HF and DD and outline the yin-yang relationship between AF, DD and HF. More recently, invasive studies have also shown that asymptomatic paroxysmal atrial fibrillation (PAF) is a common phenomenon in HF patients. We examine complex inter-relationships between PAF, HF and DD and speculate upon the possible clinical influence of undiagnosed PAF in HF patients.

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References

  1. Murphy NF, Simpson CR, Jhund PS, Stewart S, Kirkpatrick M, Chalmers J, MacIntyre K, McMurray JJV (2007) A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland. Heart 93:606–612

    Article  PubMed  Google Scholar 

  2. Heeringa J, van der Kuip DAM, Hofman A, Kors JA, van Herpen G, Stricker BHC, Stijnen T, Lip GYH, Witteman JCM (2006) Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 27:949–953

    Article  PubMed  Google Scholar 

  3. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW, Witteman JC, Stricker BH (2004) Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure the Rotterdam study. Eur Heart J 25:1614–1619

    Article  PubMed  Google Scholar 

  4. Maisel WH, Stevenson LW (2003) Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 91:2–8

    Article  Google Scholar 

  5. Savelieva I, John Camm A (2003) Atrial fibrillation and heart failure: natural history and pharmacological treatment. Europace 5:S5–19

    Article  Google Scholar 

  6. Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. J Am Coll Cardiol 32:695–703

    Article  PubMed  CAS  Google Scholar 

  7. Pedersen OD, Bagger H, Keller N, Marchant B, Kober L, Torp-Pedersen C (2001) Efficacy of Dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish investigation of arrhythmia and mortality on dofetilide (DIAMOND) sub study. Circulation 104:292–296

    PubMed  CAS  Google Scholar 

  8. Rivero-Ayerza M, Scholte op Reimer W, Lenzen M, Theuns DAMJ, Jordaens L, Komajda M, Follath F, Swedberg K, Cleland JGF (2008) New-onset atrial fibrillation is an independent predictor of in-hospital mortality in hospitalized heart failure patients: results of the Euro heart failure survey. Eur Heart J 29:1618–1624

    Article  PubMed  Google Scholar 

  9. Shelton RJ, Clark AL, Kaye GC, Cleland JG (2010) The atrial fibrillation paradox of heart failure. Congest Heart Fail 16:3–9

    Article  PubMed  CAS  Google Scholar 

  10. Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L (2009) A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail 11:676–683

    Article  PubMed  Google Scholar 

  11. Dini FL, Whalley G, Poppe K, Fontanive P, Rosa GM, Doughty RN, Di B, Di Bello V (2009) Plasma N-terminal pro type-B natriuretic peptide and restrictive mitral flow to risk-stratify patients with stage B heart failure. Clin Cardiol 32:711–717

    Article  PubMed  Google Scholar 

  12. Bruch C, Gotzmann M, Stypmann J, Wenzelburger F, Rothenburger M, Grude M, Scheld HH, Eckardt L, Breithardt G, Wichter T (2005) Electrocardiography and Doppler echocardiography for risk stratification in patients with chronic heart failure: incremental prognostic value of QRS duration and a restrictive mitral filling pattern. J Am Coll Cardiol 45:1072–1075

    Article  PubMed  Google Scholar 

  13. Gardin JM, Leifer ES, Fleg JL, Whellan D, Kokkinos P, Leblanc MH, Wolfel E, Kitzman DW (2009) Relationship of Doppler-Echocardiographic left ventricular diastolic function to exercise performance in systolic heart failure: the HF-ACTION study. Am Heart J 158:S45–S52

    Article  PubMed  Google Scholar 

  14. Hamdan A, Shapira Y, Bengal T, Mansur M, Vaturi M, Sulkes J, Battler A, Sagie A (2006) Tissue Doppler imaging in patients with advanced heart failure: relation to functional class and prognosis. J Heart Lung Transplant 25:214–218

    Article  PubMed  Google Scholar 

  15. Ren X, Ristow B, Na B, Ali S, Schiller NB, Whooley MA (2007) Prevalence and prognosis of asymptomatic left ventricular diastolic dysfunction in ambulatory patients with coronary heart disease. Am J Cardiol 99:1643–1647

    Article  PubMed  Google Scholar 

  16. Tsang TSM, Barnes ME, Gersh BJ, Bailey KR, Seward JB (2004) Risks for atrial fibrillation and congestive heart failure in patients ≥ 65 years of age with abnormal left ventricular diastolic relaxation. Am J Cardiol 93:54–58

    Article  PubMed  Google Scholar 

  17. From AM, Scott CG, Chen HH (2010) The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction: a population-based study. J Am Coll Cardiol 55:300–305

    Article  PubMed  Google Scholar 

  18. Okura H, Takada Y, Kubo T, Iwata K, Mizoguchi S, Taguchi H, Toda I, Yoshikawa J, Yoshida K (2006) Tissue Doppler-derived index of left ventricular filling pressure, E/EΓǦ, predicts survival of patients with non-valvular atrial fibrillation. Heart 92:1248–1252

    Article  PubMed  CAS  Google Scholar 

  19. Schotten U, Neuberger HR, Allessie MA (2003) The role of atrial dilatation in the domestication of atrial fibrillation. Prog Biophys Mol Biol 82:151–162

    Article  PubMed  Google Scholar 

  20. Zou R, Kneller J, Leon JL, Nattel S (2005) Substrate size as a determinant of fibrillatory activity maintenance in a mathematical model of canine atrium. Am J Physiol Heart Circ Physiol 00252

  21. Zhang YH, Youm JB, Sung HK, Lee SH, Ryu SY, Ho WK, Earm YE (2000) Stretch-activated and background non-selective cation channels in rat atrial myocytes. J Physiol 523(Pt 3):607–619

    Article  PubMed  CAS  Google Scholar 

  22. Niu W, Sachs F (2003) Dynamic properties of stretch-activated K + channels in adult rat atrial myocytes. Prog Biophys Mol Biol 82:121–135

    Article  PubMed  CAS  Google Scholar 

  23. Tomaselli GF, Marban E (1999) Electrophysiological remodelings in hypertrophy and heart failure. Cardiovasc Res 42:270–283

    Article  PubMed  CAS  Google Scholar 

  24. Solti F, Vecsey T, Kekesi V, Juhasz-Nagy A (1989) The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 23:882–886

    Article  PubMed  CAS  Google Scholar 

  25. Tisdale JE, Borzak S, Sabbah HN, Shimoyama H, Goldstein S (2006) Hemodynamic and neurohormonal predictors and consequences of the development of atrial fibrillation in dogs with chronic heart failure. J Card Fail 12:747–751

    Article  PubMed  CAS  Google Scholar 

  26. Van den Berg MP, Cruns HJ, Van Veldhuisen DJ, Griep N, De Kam PJ, Lie KI (1995) Effects of lisinopril in patients with heart failure and chronic atrial fibrillation. J Card Fail 1:355–363

    Article  Google Scholar 

  27. Zhang LM, Wang Z, Nattel S (2002) Effects of sustained beta-adrenergic stimulation on ionic currents of cultured adult guinea pig cardiomyocytes. Am J Physiol Heart Circ Physiol 282:H880–H889

    PubMed  CAS  Google Scholar 

  28. Sridhar A, Nishijima Y, Terentyev D, Khan M, Terentyeva R, Hamlin RL, Nakayama T, Gyorke S, Cardounel AJ, Carnes CA (2009) Chronic heart failure and the substrate for atrial fibrillation. Cardiovasc Res 84:227–236

    Article  PubMed  CAS  Google Scholar 

  29. Li D, Shinagawa K, Pang L, Leung TK, Cardin S, Wang Z, Nattel S (2001) Effects of angiotensin-converting enzyme inhibition on the development of the atrial fibrillation substrate in dogs with ventricular tachypacing-induced congestive heart failure. Circulation 104:2608–2614

    Article  PubMed  CAS  Google Scholar 

  30. Pedersen OD, Bagger H, Kober L, Torp-Pedersen C (1999) Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 100:376–380

    PubMed  CAS  Google Scholar 

  31. Vermes E, Tardif JC, Bourassa MG, Racine N, Levesque S, White M, Guerra PG, Ducharme A (2003) Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the studies of left ventricular dysfunction (SOLVD) trials. Circulation 107:2926–2931

    Article  PubMed  Google Scholar 

  32. Maggioni AP, Latini R, Carson PE, Singh SN, Barlera S, Glazer R, Masson S, Cere E, Tognoni G, Cohn JN (2005) Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the valsartan heart failure trial (Val-HeFT). Am Heart J 149:548–557

    Article  PubMed  CAS  Google Scholar 

  33. Ducharme A, Swedberg K, Pfeffer MA, Cohen-Solal A, Granger CB, Maggioni AP, Michelson EL, McMurray JJV, Olsson L, Rouleau JL, Young JB, Olofsson B, Puu M, Yusuf S (2006) Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in heart failure: assessment of reduction in Mortality and morbidity (CHARM) program. Am Heart J152:86–92

    Article  Google Scholar 

  34. Tsang TSM, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, Oh JK, Leibson C, Montgomery SC, Seward JB (2002) Left ventricular diastolic dysfunction as a predictor of the first diagnosed non valvular atrial fibrillation in 840 elderly men and women. J AmColl Cardiol 40:1636–1644

    Article  Google Scholar 

  35. Jons C, Moerch Joergensen R, Hassager C, Gang UJ, Dixen U, Johannesen A, Olsen NT, Hansen TF, Messier M, Huikuri HV, Bloch Thomsen PE (2010) Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy. Eur J Echocard 11:602–607

    Article  Google Scholar 

  36. Celik S, Erdol C, Baykan M, Kaplan S, Kasap H (2001) Relation between paroxysmal atrial fibrillation and left ventricular diastolic function in patients with acute myocardial infarction. Am J Cardiol 88:160–162

    Article  PubMed  CAS  Google Scholar 

  37. Tukek T, Yildiz P, Akkaya V, Karan MA, Atilgan D, Yilmaz V, Korkut F (2002) Factors associated with the development of atrial fibrillation in COPD patients: the role of P-wave dispersion. Ann Noninvasive Electrocardiol 7:222–227

    Article  PubMed  Google Scholar 

  38. Vranka I, Penz P, Dukat A (2007) Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular diastolic dysfunction in patients at risk of atrial fibrillation. Exp Clin Cardiol 12:197–201

    PubMed  Google Scholar 

  39. Sun H, Chartier D, Leblanc N, Nattel S (2001) Intracellular calcium changes and tachycardia-induced contractile dysfunction in canine atrial myocytes. Cardiovasc Res 49:751–761

    Article  PubMed  CAS  Google Scholar 

  40. Balijepalli RC, Lokuta AJ, Maertz NA, Buck JM, Haworth RA, Valdivia HH, Kamp TJ (2003) Depletion of T-tubules and specific subcellular changes in sarcolemmal proteins in tachycardia-induced heart failure. Cardiovasc Res 59:67–77

    Article  PubMed  CAS  Google Scholar 

  41. Naito M, David D, Michelson EL, Schaffenburg M, Dreifus LS (1983) The hemodynamic consequences of cardiac arrhythmias: evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model. Am Heart J 106:284–291

    Article  PubMed  CAS  Google Scholar 

  42. Clark DM, Plumb VJ, Epstein AE, Kay GN (1997) Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J Am Coll Cardiol 30:1039–1045

    Article  PubMed  CAS  Google Scholar 

  43. Pozzoli M, Cioffi G, Traversi E, Pinna GD, Cobelli F, Tavazzi L (1998) Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm. J Am Coll Cardiol 32:197–204

    Article  PubMed  CAS  Google Scholar 

  44. Byrne M, Kaye DM, Power J (2008) The synergism between atrial fibrillation and heart failure. J CardFail 14:320–326

    Google Scholar 

  45. Hagens VE, Van Veldhuisen DJ, Kamp O, Rienstra M, Bosker HA, Veeger NJGM, Tijssen JGP, Crijns HJGM, Van Gelder IC (2005) Effect of rate and rhythm control on left ventricular function and cardiac dimensions in patients with persistent atrial fibrillation: results from the rate control versus electrical cardio version for persistent atrial fibrillation (RACE) study. Heart Rhythm 2:19–24

    Article  PubMed  Google Scholar 

  46. Kosior DA, Stawicki S, Wozakowska-Kaplon B, Szulc M, Opolski G, Rabczenko D (2005) Impact of sinus rhythm restoration and maintenance on left ventricular function and exercise tolerance in patients with persistent atrial fibrillation. Kardiol Pol 63:36–47

    PubMed  Google Scholar 

  47. Hsu LF, Jais P, Sanders P, Garrigue S, Hocini M, Sacher F, Takahashi Y, Rotter M, Pasquie JL, Scavee C, Bordachar P, Clementy J, Haissaguerre M (2004) Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 351:2373–2383

    Article  PubMed  CAS  Google Scholar 

  48. Lutomsky BA, Rostock T, Koops A, Steven D, Mullerleile K, Servatius H, Drewitz I, Ueberschar D, Plagemann T, Ventura R, Meinertz T, Willems S (2008) Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging. Europace 10:593–599

    Article  PubMed  Google Scholar 

  49. Aronow WS, Ahn C, Kronzon I (2001) Prognosis of congestive heart failure after prior myocardial infarction in older persons with atrial fibrillation versus sinus rhythm. Am J Cardiol 87:224–225

    Article  PubMed  CAS  Google Scholar 

  50. Olsson LG, Swedberg K, Ducharme A, Granger CB, Michelson EL, McMurray JJV, Puu M, Yusuf S, Pfeffer MA (2006) Atrial Fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the candesartan in heart failure-assessment of reduction in mortality and morbidity (CHARM) program. J Am Coll Cardiol 47:1997–2004

    Article  PubMed  Google Scholar 

  51. Mathew J, Hunsberger S, Fleg J, Mc Sherry F, Williford W, Yusuf S (2000) Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmia’s in congestive heart failure. Chest 118:914–922

    Article  PubMed  CAS  Google Scholar 

  52. Zareba W, Steinberg JS, McNitt S, Daubert JP, Piotrowicz K, Moss AJ (2006) Implantable cardioverter-defibrillator therapy and risk of congestive heart failure or death in MADIT II patients with atrial fibrillation. Heart Rhythm 3:631–637

    Article  PubMed  Google Scholar 

  53. Swedberg K, Olsson LG, Charlesworth A, Cleland J, Hanrath P, Komajda M, Metra M, Torp-Pedersen C, Poole-Wilson P (2005) Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J 26:1303–1308

    Article  PubMed  CAS  Google Scholar 

  54. Corell P, Gustafsson F, Schou M, Markenvard J, Nielsen T, Hildebrandt P (2007) Prevalence and prognostic significance of atrial fibrillation in outpatients with heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 9:258–265

    Article  PubMed  Google Scholar 

  55. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham heart study. Circulation 107:2920–2925

    Article  PubMed  Google Scholar 

  56. Middlekauff HR, Stevenson WG, Stevenson LW (1991) Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation 84:40–48

    PubMed  CAS  Google Scholar 

  57. Pedersen OD, Brendorp B, Elming H, Pehrson S, Kber L, Torp-Pedersen C (2003) Does conversion and prevention of atrial fibrillation enhance survival in patients with left ventricular dysfunction? Evidence from the Danish investigations of arrhythmia and mortality on dofetilide/(DIAMOND) study card. Electrophys Rev 7:220–224

    Article  Google Scholar 

  58. Ahmed A, Thornton P, Perry GJ, Allman RM, DeLong JF (2004) Impact of atrial fibrillation on mortality and readmission in older adults hospitalized with heart failure. Eur J Heart Fail 6:421–426

    Article  PubMed  Google Scholar 

  59. Pai RG, Varadarajan P (2007) Prognostic significance of atrial fibrillation is a function of left ventricular ejection fraction. Clin Cardiol 30:349–354

    Article  PubMed  Google Scholar 

  60. Crijns HJGM, Tjeerdsma G, de Kam PJ, Boomsma F, Van Gelder IC, van den Berg MP, van Veldhuisen DJ (2000) Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure. Eur Heart J 21:1238–1245

    Article  PubMed  CAS  Google Scholar 

  61. Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN (1993) The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT studies. The V-HeFT VA cooperative studies group. Circulation 87:VI102–VI110

    PubMed  CAS  Google Scholar 

  62. Mahoney P, Kimmel S, DeNofrio D, Wahl P, Loh E (1999) Prognostic significance of atrial fibrillation in patients at a tertiary medical centre referred for heart transplantation because of severe heart failure. Am J Cardiol 83:1544–1547

    Article  PubMed  CAS  Google Scholar 

  63. Stevenson WG, Stevenson LW, Fonarow GC, Middlekauff HR, Hamilton MA, Woo MA, Saxon LA, Natterson PD, Steimle A, Walden JA, Tillisch JH (1996) Improving survival for patients with atrial fibrillation and advanced heart failure. J Am Coll Cardiol 28:1458–1463

    Article  PubMed  CAS  Google Scholar 

  64. Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, Guerra PG, Hohnloser SH, Lambert J, Le Heuzey JY, O’Hara G, Pedersen OD, Rouleau JL, Singh BN, Stevenson LW, Stevenson WG, Thibault B, Waldo AL, The Atrial Fibrillation, Congestive Heart Failure Investigators (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358:2667–2677

    Article  PubMed  CAS  Google Scholar 

  65. Fung JWH, Yip GWK, Zhang Q, Fang F, Chan JYS, Li CM, Wu LW, Chan GCP, Chan HCK, Yu CM (2008) Improvement of left atrial function is associated with lower incidence of atrial fibrillation and mortality after cardiac resynchronization therapy. Heart Rhythm 5:780–786

    Article  PubMed  Google Scholar 

  66. Lee SH, Choi S, Chung WJ, Byun YS, Ryu SK, Pyun WB, Rim SJ (2008) Tissue Doppler index, E/E’, and ischemic stroke in patients with atrial fibrillation and preserved left ventricular ejection fraction. J Neuro Sc 271:148–152

    Article  Google Scholar 

  67. Tabata T, Grimm RA, Asada J, Popovic ZB, Yamada H, Greenberg NL, Wallick DW, Zhang Y, Zhuang S, Mowrey KA, Thomas JD, Mazgalev TN (2004) Determinants of LV diastolic function during atrial fibrillation: beat-to-beat analysis in acute dog experiments. Am J Physiol Heart Circ Physiol 286:H145–H152

    Article  PubMed  CAS  Google Scholar 

  68. Yu CM, Wang Q, Lau CP, Tse HF, Leung SK, Lee KL, Tsang V, Ayers G (2001) Reversible impairment of left and right ventricular systolic and diastolic function during short-lasting atrial fibrillation in patients with an implantable atrial defibrillator: a tissue Doppler imaging study. Pacing Clin Electrophysiol 24:979–988

    Article  PubMed  CAS  Google Scholar 

  69. Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA (1995) Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 92:1954–1968

    PubMed  CAS  Google Scholar 

  70. LIP GY, Lim HS (2000) Asymptomatic atrial fibrillation on device interrogation. J Cardiovasc Electrophysiol 19:891–893

    Google Scholar 

  71. Li D, Fareh S, Leung TK, Nattel S (1999) Promotion of atrial fibrillation by heart failure in dogs: atrial remodelling of a different sort. Circulation 100:87–95

    PubMed  CAS  Google Scholar 

  72. Cardin S, Li D, Thorin-Trescases N, Leung TK, Thorin E, Nattel S (2003) Evolution of the atrial fibrillation substrate in experimental congestive heart failure: angiotensin-dependent and -independent pathways. Cardiovasc Res 60:315–325

    Article  PubMed  CAS  Google Scholar 

  73. Caldwell JC, Contractor H, Petkar S, Ali R, Clarke B, Garratt CJ, Neyses L, Mamas M (2009) Atrial fibrillation is under recognised in chronic heart failure—insights from a heart failure cohort treated with CRT therapy. Europace 11:1295–1300

    Article  PubMed  Google Scholar 

  74. Caldwell J, Mamas M, Garratt C, Neyses L (2008) How common is asymptomatic paroxysmal atrial fibrillation in chronic heart failure? Scand Cardiovasc J 18(1):1

    Google Scholar 

  75. Sakabe K, Fukuda N, Fukuda Y, Morishita S, Shinohara H, Tamura Y (2009) Prediction of transition to chronic atrial fibrillation in elderly patients with non valvular paroxysmal atrial fibrillation by transthoracic Doppler echocardiography. Clin Cardiol 32:E23–E28

    Article  PubMed  Google Scholar 

  76. Koitabashi T, Inomata T, Niwano S, Nishii M, Takeuchi I, Nakano H, Shinagawa H, Takehana H, Izumi T (2005) Paroxysmal atrial fibrillation coincident with cardiac decompensation is a predictor of poor prognosis in chronic heart failure. Circ J 69:823–830

    Article  PubMed  Google Scholar 

  77. Puglisi A, Gaspini M, Lunati M, Sassara M, Padeletti L, Landolina M, Botto GL, Vincenti A, Bianchi S, Denaro A, Grammatico A, Boriani G (2000) Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients. J Cardiovasc Electrophysiol 19:693–701

    Article  Google Scholar 

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Caldwell, J.C., Mamas, M.A. Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex inter-relationship. Heart Fail Rev 17, 27–33 (2012). https://doi.org/10.1007/s10741-010-9204-4

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