LAUSR

Objective: Deterioration of ventricular-arterial coupling (VAC) might be the leading cause of left ventricular diastolic dysfunction (DD) and therefore developing atrial fibrillation (AF). The effects of class III antiarrhythmic drugs on VAC and DD remain unclear. We tried to compare the effects of amiodarone and sotalol on left ventricular diastolic function and VAC parameters in patients with paroxysmal or persistent AF and left ventricular DD. Design and method: Sixty patients [45% male, median age 65 (61; 72) years] with recurrent AF and mild to moderate DD were enrolled in this study and treated with 200 mg of amiodarone (A group) + 50 mg of metoprolol daily (n = 30) or 160 mg of sotalol (S group) daily (n = 30). All the patients underwent Doppler echocardiography and speckle tracking analysis. To assess VAC arterial elastance index (EaI), left ventricular end-systolic elastance index (EesI), Ea/Ees, systemic vascular resistance index (SVRI) and total arterial compliance (TAC) were calculated. The duration of the follow-up period was 3 months. Results: A similar change in most clinical and echocardiographic parameters was observed in both groups. EesI significantly decreased in the two groups (from 1.41 to 1.25 in A group and from 1.7 to 1.6 in S group, p for all < 0.001), while TAC increased (from 1.15 to 1.35 in A group and from 1.11 to 1.4 in S group, p for all < 0.001). There was no significant change in EaI in A and S groups; similarly, SVRI was stable during the observation. The improvement of left ventricular global longitudinal strain (&dgr;: −1.9 vs −0.81, p < 0.001), left atrial (LA) size (&dgr;: −2 vs −1.1, p = 0.02), deceleration time (&dgr;: −2 vs −1, p < 0.001), E/A ratio (&dgr;: −0.18 vs −0.08, p = 0.01) and E/E’ (&dgr;: −2.07 vs −1.2, p = 0.008) was significantly more pronounced in A group. Conclusions: While the antiarrhythmic qualities of the two drugs were similar, amiodarone had a more favorable effect on left ventricular diastolic function and LA size. VAC parameters changed comparably in A and S groups during the course of treatment.