Impaired adaptation to left atrial pressure increase in patients with atrial fibrillation

Gergely Ágoston, Judit Szilágyi, Gábor Bencsik, Cristina Tutuianu, Gergely Klausz, László Sághy, Albert Varga, Tamás Forster, Róbert Pap

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background or purpose: Episodes of left atrial (LA) pressure increase predispose to atrial fibrillation (AF). The adaptation of LA mechanical function and electrophysiology to pressure elevation in healthy adults, and in patients with AF, is largely unknown. Methods: Eleven patients with left-sided accessory pathway (controls) and 16 patients with paroxysmal AF undergoing catheter ablation were studied. LA pressure (LAP) was recorded through transseptal catheterization, while speckle tracking-derived peak LA longitudinal strain (PALS) was measured using transthoracic echocardiography. Stiffness index (SI) was calculated as mean LAP/PALS. Effective refractory period (ERP) of the LA was determined during simultaneous atrioventricular (AV) pacing and during atrial pacing. Results: At baseline, AF patients had higher LA pressure (mean LAP 8.3 ± 4.7 vs. 5.1 ± 3.1 mmHg, p = 0.048), reduced LA mechanical function (PALS 15.1 ± 5.1 vs. 21.6 ± 6.2 %, p = 0.006, SI 0.69 ± 0.75 vs. 0.28 ± 0.22, p = 0.015), and longer LA ERP (242.3 ± 33.4 vs. 211.7 ± 15.6 ms, p = 0.017). Mean LAP was increased to the same extent by AV pacing in controls and AF patients (mean change 12.6 ± 7.4 vs. 12.6 ± 7.5 mmHg, p = 0.980). At the same time PALS decreased (from 15.1 ± 5.1 to 11.6 ± 3.3 %, p = 0.008), SI increased (from 0.69 ± 0.75 to 1.29 ± 1.17, p < 0.001) and ERP shortened (from 242.3 ± 33.4 to 215.9 ± 26.3 ms, p = 0.003) in AF patients, while they remained unchanged in controls. Conclusions: The stiffened LA in patients with AF responds to acute pressure elevation with an exaggerated increase in wall tension and decrease in ERP, which is not seen in the normal LA. This may underlie the propensity for AF during episodes of atrial stretch in these patients.

Original languageEnglish
Pages (from-to)113-118
Number of pages6
JournalJournal of Interventional Cardiac Electrophysiology
Volume44
Issue number2
DOIs
Publication statusPublished - Nov 1 2015

Keywords

  • Atrial fibrillation
  • Left atrial pressure
  • Left atrial strain
  • Mechanoelectric feedback

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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