The hemodynamic effect of simulated atrial fibrillation on left ventricular function
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
36069129
DOI
10.1111/jce.15669
Knihovny.cz E-resources
- Keywords
- arrhythmia, atrial fibrillation, hemodynamics, his bundle pacing,
- MeSH
- Atrial Fibrillation * diagnosis surgery MeSH
- Ventricular Function, Left MeSH
- Hemodynamics MeSH
- Cardiac Pacing, Artificial MeSH
- Catheter Ablation * adverse effects MeSH
- Humans MeSH
- Heart Rate MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION: Atrial fibrillation (AF) is the most common sustained arrhythmia in humans. The onset of the arrhythmia can significantly impair cardiac function. This hemodynamic deterioration has been explained by several mechanisms such as the loss of atrial contraction, shortening of ventricular filling, or heart rhythm irregularity. This study sought to evaluate the relative hemodynamic contribution of each of these components during in vivo simulated human AF. METHODS: Twelve patients undergoing catheter ablation for paroxysmal AF were paced simultaneously from the proximal coronary sinus and the His bundle region according to prescribed sequences of irregular R-R intervals with the average rate of 90 and 130 bpm, which were extracted from the database of digital ECG recordings of AF from other patients. The simulated AF was compared to regular atrial pacing with spontaneous atrioventricular conduction and regular simultaneous atrioventricular pacing at the same heart rate. Beat-by-beat left atrial and left ventricular pressures, including LV dP/dT and Tau index were assessed by direct invasive measurement; beat-by-beat stroke volume and cardiac output (index) were assessed by simultaneous pulse-wave doppler intracardiac echocardiography. RESULTS: Simulated AF led to significant impairment of left ventricular systolic and diastolic function. Both loss of atrial contraction and heart rate irregularity significantly contributed to hemodynamic impairment. This effect was pronounced with increasing heart rate. CONCLUSION: Our findings strengthen the rationale for therapeutic strategies aiming at rhythm control and heart rate regularization in patients with AF.
Institute for Clinical and Experimental Medicine Prague Czech Republic
Institute of Physiology 1st Faculty of Medicine Charles University Prague Czech Republic
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