Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation

Department of Medicine, University of Alabama at Birmingham 35294, USA.

OBJECTIVES: The aim of this study was to determine the independent hemodynamic effects of an irregular sequence of ventricular cycle lengths in patients with atrial fibrillation (AF). BACKGROUND: Atrial fibrillation may reduce cardiac output by several possible mechanisms, including loss of the atrial contribution to left ventricular filling, valvular regurgitation, increased ventricular rate or irregular RR intervals. This study was designed to evaluate the effects of an irregular RR interval, independent of the average ventricular rate, on cardiac hemodynamic data during AF. METHODS: Sixteen patients with AF were studied invasively. During intrinsically conducted AF (mean rate 102 +/- 22 beats/ min), the right ventricular apex electrogram was recorded onto frequency-modulated (FM) tape. After atrioventricular node ablation, the right ventricular apex was stimulated in three pacing modes in randomized sequence: 1) VVI at 60 beats/min; 2) VVI at the same average rate as during intrinsically conducted AF (102 +/- 22 beats/min); and 3) during VVT pacing in which the pacemaker was triggered by playback of the FM tape recording of the right ventricular apex electrogram previously recorded during intrinsically conducted AF (VVT 102 +/- 22 beats/min). RESULTS: Compared with VVI pacing at the same average rate, an irregular sequence of RR intervals decreased cardiac output (4.4 +/- 1.6 vs. 5.2 +/- 2.4 liters/min, p < 0.01), increased pulmonary capillary wedge pressure (17 +/- 7 vs. 14 +/- 6 mm Hg, p < 0.002) and increased right atrial pressure (10 +/- 6 vs. 8 +/- 4 mm Hg, p < 0.05). CONCLUSIONS: An irregular sequence of RR intervals produces adverse hemodynamic consequences that are independent of heart rate.

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				V. Melenovsky, I. Hay, B. J. Fetics, B. A. Borlaug, A. Kramer, J. M. Pastore, R. Berger, and D. A. Kass Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy Eur. Heart J., April 1, 2005; 26(7): 705 - 711. [Abstract] [Full Text] [PDF]

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				E. Puggioni, M. Brignole, M. Gammage, E. Soldati, M. G. Bongiorni, E. N. Simantirakis, P. Vardas, F. Gadler, L. Bergfeldt, C. Tomasi, et al. Acute comparative effect of right and left ventricular pacing in patients with permanent atrial fibrillation J. Am. Coll. Cardiol., January 21, 2004; 43(2): 234 - 238. [Abstract] [Full Text] [PDF]

				T. Deneke, T. Lawo, B. Gerritse, B. Lemke, and for the European GEM DRTM Investigators Mortality of patients with implanted cardioverter/defibrillators in relation to episodes of atrial fibrillation Europace, January 1, 2004; 6(2): 151 - 158. [Abstract] [Full Text] [PDF]

				G. Mazzocca, T. Giovannini, F. Frascarelli, A. Fabiani, A. Burali, G. Giappichini, G. Bidi, D. Bernaḅ, E. Manfredini, and G. Corbucci Heart rate regularisation in patients with permanent atrial fibrillation implanted with a VVI(R) pacemaker Europace, January 1, 2004; 6(3): 236 - 242. [Abstract] [Full Text] [PDF]

				L. Bergfeldt and Y. Haga Power spectral and Poincare plot characteristics in sinus node dysfunction J Appl Physiol, June 1, 2003; 94(6): 2217 - 2224. [Abstract] [Full Text] [PDF]

				S. L. Wasmund, J.-M. Li, R. L. Page, J. A. Joglar, R. C. Kowal, M. L. Smith, and M. H. Hamdan Effect of Atrial Fibrillation and an Irregular Ventricular Response on Sympathetic Nerve Activity in Human Subjects Circulation, April 22, 2003; 107(15): 2011 - 2015. [Abstract] [Full Text] [PDF]

				I. Savelieva and A. John Camm Atrial fibrillation and heart failure: natural history and pharmacological treatment Europace, January 1, 2003; 5(s1): S5 - S19. [Abstract] [Full Text] [PDF]

				L. Padeletti, N. Musilli, M. C. Porciani, A. Colella, L. Di Biase, G. Ricciardi, P. Pieragnoli, A. Michelucci, and G. Gensini Atrial fibrillation and cardiac resynchronization therapy: the MASCOT study Europace, January 1, 2003; 5(s1): S49 - S54. [Abstract] [Full Text] [PDF]

				Z. B. Popovic', K. A. Mowrey, Y. Zhang, S. Zhuang, T. Tabata, D. W. Wallick, R. A. Grimm, J. D. Thomas, and T. N. Mazgalev Slow rate during AF improves ventricular performance by reducing sensitivity to cycle length irregularity Am J Physiol Heart Circ Physiol, December 1, 2002; 283(6): H2706 - H2713. [Abstract] [Full Text] [PDF]

				M. Brignole A novel use of cardiac pacing to improve cardiac function, quality of life and (hopefully) survival in patients with heart failure and permanent atrial fibrillation Eur. Heart J., November 2, 2002; 23(22): 1732 - 1736. [Full Text] [PDF]

				E. Bertaglia, D. D'Este, F. Zerbo, F. Zoppo, P. Delise, and P. Pascotto Success of serial external electrical cardioversion of persistent atrial fibrillation in maintaining sinus rhythm. A randomized study Eur. Heart J., October 1, 2002; 23(19): 1522 - 1528. [Abstract] [Full Text] [PDF]

				M. P. van den Berg, I. C. van Gelder, and D. J. van Veldhuisen Impact of atrial fibrillation on mortality in patients with chronic heart failure Eur J Heart Fail, October 1, 2002; 4(5): 571 - 575. [Abstract] [Full Text] [PDF]

				J. P. DiMarco Selective Vagal Stimulation for Rate Control in Atrial Fibrillation Circulation, October 1, 2002; 106(14): 1746 - 1747. [Full Text] [PDF]

				S. Zhuang, Y. Zhang, K. A. Mowrey, J. Li, T. Tabata, D. W. Wallick, Z. B. Popovic, R. A. Grimm, A. Natale, and T. N. Mazgalev Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation Circulation, October 1, 2002; 106(14): 1853 - 1858. [Abstract] [Full Text] [PDF]

				K. M. Stein, D. E. Euler, R. Mehra, K. Seidl, D. J. Slotwiner, S. Mittal, S. M. Markowitz, B. B. Lerman, and Jewel AF Worldwide Investigators Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients? J. Am. Coll. Cardiol., July 17, 2002; 40(2): 335 - 340. [Abstract] [Full Text] [PDF]

				J. M. Cooper, M. S. Katcher, and M. V. Orlov Implantable Devices for the Treatment of Atrial Fibrillation N. Engl. J. Med., June 27, 2002; 346(26): 2062 - 2068. [Full Text] [PDF]

				K. Nanthakumar and G.N. Kay The deleterious effects of an irregular RR interval Eur. Heart J., May 1, 2002; 23(9): 695 - 696. [Full Text] [PDF]

				G.E. Kochiadakis, E.I. Skalidis, M.D. Kalebubas, N.E. Igoumenidis, S.I. Chrysostomakis, E.M. Kanoupakis, E.N. Simantirakis, and P.E. Vardas Effect of acute atrial fibrillation on phasic coronary blood flow pattern and flow reserve in humans Eur. Heart J., May 1, 2002; 23(9): 734 - 741. [Abstract] [Full Text] [PDF]

				I. l S. Kim, H. Izawa, T. Sobue, H. Ishihara, F. Somura, T. Nishizawa, K. Nagata, M. Iwase, and M. Yokota Prognostic value of mechanical efficiency in ambulatory patients with idiopathic dilated cardiomyopathy in sinus rhythm J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1264 - 1268. [Abstract] [Full Text] [PDF]

				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology Circulation, October 23, 2001; 104(17): 2118 - 2150. [Full Text] [PDF]

				Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]

				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1231 - 1265. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]

				J. Azpitarte, O. Baun, E. Moreno, R. Garcia-Orta, J. Sanchez-Ramos, and L. Tercedor In Patients With Chronic Atrial Fibrillation and Left Ventricular Systolic Dysfunction, Restoration of Sinus Rhythm Confers Substantial Benefit Chest, July 1, 2001; 120(1): 132 - 138. [Abstract] [Full Text] [PDF]

				S. S. Chugh, J. L. Blackshear, W.-K. Shen, S. C. Hammill, and B. J. Gersh Epidemiology and natural history of atrial fibrillation: clinical implications J. Am. Coll. Cardiol., February 1, 2001; 37(2): 371 - 378. [Abstract] [Full Text] [PDF]

				T Levy, S Walker, M Mason, P Spurrell, S Rex, S Brant, and V Paul Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study Heart, February 1, 2001; 85(2): 171 - 178. [Abstract] [Full Text]

				M. Brignole and M. Gammage A novel use of cardiac pacing to improve cardiac function in patients with heart failure and permanent atrial fibrillation Europace, January 1, 2001; 3(2): 150 - 152. [PDF]

				M. H. Hamdan, R. L. Page, C. J. Sheehan, J. D. Zagrodzky, S. L. Wasmund, K. Ramaswamy, J. A. Joglar, and M. L. Smith Increased sympathetic activity after atrioventricular junction ablation in patients with chronic atrial fibrillation J. Am. Coll. Cardiol., July 1, 2000; 36(1): 151 - 158. [Abstract] [Full Text] [PDF]

				H J Muntinga, A T M Gosselink, P K Blanksma, P J De Kam, E E V. D. Wall, and H J G M Crijns Left ventricular beat to beat performance in atrial fibrillation: dependence on contractility, preload, and afterload Heart, November 1, 1999; 82(5): 575 - 580. [Abstract] [Full Text]

				A E Tuinenburg, I C Van Gelder, M P V. Den Berg, J Brugemann, P J De Kam, and H J G M Crijns Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation Heart, October 1, 1999; 82(4): 486 - 493. [Abstract] [Full Text] [PDF]

				W. G. Stevenson and L. W. Stevenson Atrial Fibrillation in Heart Failure N. Engl. J. Med., September 16, 1999; 341(12): 910 - 911. [Full Text]

				M. M. Scheinman Atrial Fibrillation and Congestive Heart Failure : The Intersection of Two Common Diseases Circulation, September 8, 1998; 98(10): 941 - 942. [Full Text] [PDF]

				M. Brignole, C. Menozzi, L. Gianfranchi, G. Musso, R. Mureddu, N. Bottoni, and G. Lolli Assessment of Atrioventricular Junction Ablation and VVIR Pacemaker Versus Pharmacological Treatment in Patients With Heart Failure and Chronic Atrial Fibrillation : A Randomized, Controlled Study Circulation, September 8, 1998; 98(10): 953 - 960. [Abstract] [Full Text] [PDF]

				D. Dries, D. Exner, B. Gersh, M. Domanski, M. Waclawiw, and L. Stevenson Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials J. Am. Coll. Cardiol., September 1, 1998; 32(3): 695 - 703. [Abstract] [Full Text] [PDF]

				Y. Zhang, K. A. Mowrey, S. Zhuang, D. W. Wallick, Z. B. Popovic, and T. N. Mazgalev Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H1102 - H1110. [Abstract] [Full Text] [PDF]