Barrows Rosie K, Augustin Christoph M, Gsell Matthias A F, Roney Caroline H, Solís Lemus José A, Xu Hao, Young Alistair A, Rajani Ronak, Whitaker John, Vigmond Edward J, Bishop Martin J, Plank Gernot, Strocchi Marina, Niederer Steven A
School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Heart Rhythm O2. 2025 May 9;6(7):1011-1019. doi: 10.1016/j.hroo.2025.04.014. eCollection 2025 Jul.
Atrial fibrillation (AF) alters heart rate, rhythm regularity, and atrial contraction, which may contribute to an increased risk of heart failure. Although rate and rhythm control target different aspects of these disturbances, their specific effects on left ventricular (LV) function remain unclear.
The purpose of this study was to predict the independent and combined contribution of heart rate, rhythm regularity, and atrial contraction to LV function in patients with AF.
We predicted LV ejection fraction (EF) and stroke volume (SV) in 10 whole-heart patient-specific models of patients with AF while varying heart rate, rhythm regularity, and effectiveness of atrial contraction.AF was modeled as a fast, irregular heart rate with no atrial contraction. Pharmacologic and paced rate control were modeled as a slow irregular and regular heart rate without atrial contraction, respectively, whereas rhythm control had a slow, regular heart rate with atrial contraction.
Rhythm control resulted in a greater improvement than pharmacological rate control in LVEF compared with AF (+5.1% ± 0.4% vs +2.8% ± 0.3%, < .01). Paced rate control was equivalent to pharmacologic rate control in terms of LVEF (+2.6% ± 0.4% vs +2.8% ± 0.3%). Atrial contraction did not improve ventricular function in the presence of an irregular heart rate (pharmacologic rate: +2.8% ± 0.3% vs rhythm with irregular heart rate: +2.7% ± 0.3%).
Rhythm control provides superior improvements in LV function compared with rate control. However, restoring sinus rhythm may yield limited benefits to LV function when atrial contraction is ineffective or when heart rate is irregular.
心房颤动（AF）会改变心率、节律规则性和心房收缩，这可能会增加心力衰竭的风险。尽管心率控制和节律控制针对这些紊乱的不同方面，但它们对左心室（LV）功能的具体影响仍不清楚。
本研究的目的是预测心率、节律规则性和心房收缩对AF患者LV功能的独立和联合作用。
我们在10个AF患者的全心脏个体化模型中预测左心室射血分数（EF）和每搏输出量（SV），同时改变心率、节律规则性和心房收缩的有效性。AF被模拟为快速、不规则的心率且无心房收缩。药物性心率控制和起搏心率控制分别被模拟为缓慢不规则和规则的心率且无心房收缩，而节律控制则是缓慢、规则的心率且有心房收缩。
与AF相比，节律控制导致左心室射血分数的改善比药物性心率控制更大（分别为+5.1%±0.4%和+2.8%±0.3%，P<0.01）。就左心室射血分数而言，起搏心率控制与药物性心率控制相当（分别为+2.6%±0.4%和+2.8%±0.3%）。在心率不规则的情况下，心房收缩并未改善心室功能（药物性心率控制：+2.8%±0.3%，与心率不规则时的节律控制：+2.7%±0.3%）。
与心率控制相比，节律控制能使左心室功能得到更显著的改善。然而，当心房收缩无效或心率不规则时，恢复窦性心律对左心室功能的益处可能有限。
