Document Detail

Does acute-phase beta blockade reduce left atrial appendage function in patients with chronic nonvalvular atrial fibrillation?
MedLine Citation:
PMID:  11241015     Owner:  NLM     Status:  MEDLINE    
To investigate whether acute-phase beta-blocker therapy has a harmful effect on left atrial appendage (LAA) function in patients with chronic nonvalvular atrial fibrillation by transesophageal echocardiography (TEE), we evaluated 21 patients with normal left ventricular systolic function and a poorly controlled ventricular rate, despite the use of digoxin. Baseline parameters that were obtained included heart rate, blood pressure, LAA emptying velocities, and left atrial spontaneous echo contrast intensity. Then, each patient was given a bolus dose of 5 mg metoprolol. Ten minutes later, a second set of assessments was performed. After the first TEE studies, each patient began treatment with metoprolol (50 mg orally twice daily for 1 week). A second TEE study was performed after 1 week of continuous oral metoprolol therapy at maintenance dose, and values were again determined. The average resting apical heart rate was 91 +/- 7 bpm. As expected, beta-blocker therapy showed a marked decrease in heart rate at 10 minutes (79 +/- 6 bpm, P <.001) and at 1 week (71 +/- 4 bpm, P <.001). Beta-blocker therapy caused a significant reduction in systolic and diastolic blood pressures (144 +/- 16 / 93 +/- 6 mm Hg at baseline, 137 +/- 16 / 87 +/- 9 mm Hg at 10 minutes, and 135 +/- 12 / 86 +/- 8 mm Hg at 1 week, P <.001). With the beta-blocker therapy, the baseline transesophageal Doppler parameter of LAA emptying velocities (at baseline 24 +/- 7 cm/s) fell significantly at 10 minutes (19 +/- 7 cm/s, P <.001) and at 1 week (17 +/- 6 cm/s, P <.001) after initiation of beta-blocker therapy. After a bolus of metoprolol, spontaneous echo contrast intensity did not change in any patients, but 1 week later, it increased in 1 patient. In 2 patients who had not been found to have an LAA thrombus at baseline TEE study, the second TEE examination demonstrated new thrombi in the LAA. In conclusion, our findings suggest that in patients with chronic nonvalvular atrial fibrillation who have normal left ventricular systolic function and a poorly controlled ventricular rate despite the use of digoxin, acute-phase beta blockade may have a harmful effect on LAA function.
M Bilge; N Güler; B Eryonucu; R Erkoç
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  14     ISSN:  0894-7317     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-03-12     Completed Date:  2001-05-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  194-9     Citation Subset:  IM    
Departments of Cardiology, Medical Faculty, Yüzüncü Yil University, Van, Turkey.
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MeSH Terms
Adrenergic beta-Antagonists / adverse effects*
Atrial Appendage / drug effects*,  physiopathology,  ultrasonography
Atrial Fibrillation / drug therapy*,  physiopathology,  ultrasonography
Chronic Disease
Echocardiography, Doppler
Echocardiography, Transesophageal
Metoprolol / adverse effects*
Middle Aged
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 37350-58-6/Metoprolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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