Stojadinović Predrag, Deshraju Aslesha, Wichterle Dan, Fukunaga Masato, Peichl Petr, Kautzner Josef, Šramko Marek
Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
J Cardiovasc Electrophysiol. 2022 Dec;33(12):2569-2577. doi: 10.1111/jce.15669. Epub 2022 Sep 18.
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.
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.
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.
Our findings strengthen the rationale for therapeutic strategies aiming at rhythm control and heart rate regularization in patients with AF.
心房颤动（AF）是人类最常见的持续性心律失常。心律失常的发作会显著损害心脏功能。这种血流动力学恶化已通过多种机制得到解释，如心房收缩丧失、心室充盈缩短或心律不齐。本研究旨在评估在体内模拟人类房颤期间这些因素各自对血流动力学的相对贡献。
12例接受阵发性房颤导管消融治疗的患者，根据从其他患者房颤数字心电图记录数据库中提取的不规则R-R间期规定序列，分别从冠状窦近端和希氏束区域同时进行起搏，平均心率分别为90次/分和130次/分。将模拟房颤与具有自发房室传导的规则心房起搏以及相同心率下的规则同步房室起搏进行比较。通过直接有创测量评估逐搏左心房和左心室压力，包括左心室dP/dT和Tau指数；通过同步脉冲波多普勒心内超声心动图评估逐搏每搏输出量和心输出量（指数）。
模拟房颤导致左心室收缩和舒张功能显著受损。心房收缩丧失和心律不齐均对血流动力学损害有显著影响。随着心率增加，这种影响更为明显。
我们的研究结果强化了针对房颤患者进行节律控制和心率规整的治疗策略的理论依据。
