Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy.
Department of Medical Sciences, University of Turin, Turin, Italy.
Sci Rep. 2023 Apr 25;13(1):6751. doi: 10.1038/s41598-023-33952-z.
Atrial fibrillation (AF)-induced peripheral microcirculatory alterations have poorly been investigated. The present study aims to expand current knowledge through a beat-to-beat analysis of non-invasive finger photoplethysmography (PPG) in AF patients restoring sinus rhythm by electrical cardioversion (ECV). Continuous non-invasive arterial blood pressure and left middle finger PPG pulse oximetry waveform (POW) signals were continuously recorded before and after elective ECV of consecutive AF or atrial flutter (AFL) patients. The main metrics (mean, standard deviation, coefficient of variation), as well as a beat-to-beat analysis of the pulse pressure (PP) and POW beat-averaged value (aPOW), were computed to compare pre- and post-ECV phases. 53 patients (mean age 69 ± 8 years, 79% males) were enrolled; cardioversion was successful in restoring SR in 51 (96%) and signal post-processing was feasible in 46 (87%) patients. In front of a non-significant difference in mean PP (pre-ECV: 51.96 ± 13.25, post-ECV: 49.58 ± 10.41 mmHg; p = 0.45), mean aPOW significantly increased after SR restoration (pre-ECV: 0.39 ± 0.09, post-ECV: 0.44 ± 0.06 a.u.; p < 0.001). Moreover, at beat-to-beat analysis linear regression yielded significantly different slope (m) for the PP (RR) relationship compared to aPOW(RR) [PP(RR): 0.43 ± 0.18; aPOW(RR): 1.06 ± 0.17; p < 0.001]. Long (> 95th percentile) and short (< 5th percentile) RR intervals were significantly more irregular in the pre-ECV phases for both PP and aPOW; however, aPOW signal suffered more fluctuations compared to PP (p < 0.001 in both phases). Present findings suggest that AF-related hemodynamic alterations are more manifest at the peripheral (aPOW) rather than at the upstream macrocirculatory level (PP). Restoring sinus rhythm increases mean peripheral microvascular perfusion and decreases variability of the microvascular hemodynamic signals. Future dedicated studies are required to determine if AF-induced peripheral microvascular alterations might relate to long-term prognostic effects.
心房颤动（AF）引起的外周微循环改变研究甚少。本研究旨在通过对电复律（ECV）恢复窦性节律的 AF 或房扑（AFL）患者的无创手指光体积描记法（PPG）进行逐拍分析来扩展现有知识。连续记录了择期 ECV 前后连续 AF 或 AFL 患者的连续无创动脉血压和左中指 PPG 脉搏血氧仪波形（POW）信号。计算了主要指标（平均值、标准差、变异系数）以及脉压（PP）和 POW 拍平均（aPOW）的逐拍分析，以比较 ECV 前后阶段。共纳入 53 例患者（平均年龄 69±8 岁，79%为男性）；51 例（96%）成功复律恢复 SR，46 例（87%）可行信号后处理。在平均 PP 无显著差异的情况下（ECV 前：51.96±13.25，ECV 后：49.58±10.41mmHg；p=0.45），SR 恢复后平均 aPOW 显著增加（ECV 前：0.39±0.09，ECV 后：0.44±0.06a.u.；p<0.001）。此外，在逐拍分析中，PP（RR）关系的线性回归斜率（m）与 aPOW（RR）显著不同[PP（RR）：0.43±0.18；aPOW（RR）：1.06±0.17；p<0.001]。PP 和 aPOW 在 ECV 前阶段的长（>95 百分位数）和短（<5 百分位数）RR 间隔均显著更不规则；然而，与 PP 相比，aPOW 信号波动更大（在两个阶段均 p<0.001）。目前的研究结果表明，AF 相关的血流动力学改变在外周（aPOW）比在上游大循环水平（PP）更为明显。恢复窦性节律可增加平均外周微血管灌注，并降低微血管血流动力学信号的变异性。需要进一步的专门研究来确定 AF 引起的外周微血管改变是否与长期预后效果有关。
