Tilman V
The Sheba Medical Center, Rehabilitation Hospital, Ramat Gan, Israel.
Med Hypotheses. 2014 Sep;83(3):299-301. doi: 10.1016/j.mehy.2014.05.024. Epub 2014 Jun 12.
Atrial fibrillation in heart failure often occur together. The relationship between atrial fibrillation and heart failure has remained a subject of research. The main manifestation of the violation of hydrodynamics in heart failure is the increased end-diastolic pressure, which is transmitted through the intercommunicated system (left ventricle-left atrium-pulmonary veins-alveolar capillaries) causing increased pulmonary wedge pressure with the danger for pulmonary edema. End-diastolic pressure is the sum of left ventricle diastolic pressure and left atrial systolic pressure. Stopping the mechanical systole of the left atrium can reduce the pressure in the system in heart failure. Atrial fibrillation stops the mechanical systole of the left atrium and decreases the intercommunicating pressure and pulmonary wedge pressure. It is possible that atrial fibrillation is a mechanism for protection from increasing end-diastolic pressure and pulmonary wedge pressure, and prevents the danger of pulmonary edema. This hypothesis may explain the relationship between heart failure and atrial fibrillation and their frequent association.
心力衰竭常与心房颤动同时出现。心房颤动与心力衰竭之间的关系一直是研究的课题。心力衰竭中流体动力学紊乱的主要表现是舒张末期压力升高,该压力通过相互连通的系统(左心室-左心房-肺静脉-肺泡毛细血管)传导,导致肺楔压升高,存在肺水肿风险。舒张末期压力是左心室舒张压与左心房收缩压之和。停止左心房的机械收缩可降低心力衰竭时系统内的压力。心房颤动会停止左心房的机械收缩,降低相互连通的压力和肺楔压。心房颤动可能是一种防止舒张末期压力和肺楔压升高的机制,并预防肺水肿的危险。这一假说或许可以解释心力衰竭与心房颤动之间的关系及其频繁关联。