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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Isolated Atrial Microvascular Dysfunction in Patients With Lone Recurrent Atrial Fibrillation

Emmanuel I. Skalidis, MD^_*, Michalis I. Hamilos, MD^_*, Ioannis K. Karalis, MD^_*, Gregory Chlouverakis, PhD, George E. Kochiadakis, MD^_* and Panos E. Vardas, MD, PhD, FESC, FACC^_*,_*

^_* Cardiology Department, University Hospital of Heraklion, Heraklion, Greece
Biostatistics Lab, University of Crete, Heraklion, Greece.

Manuscript received October 15, 2007; revised manuscript received January 17, 2008, accepted January 21, 2008.

^_* Reprint requests and correspondence: Prof. Panos E. Vardas, Cardiology Department, Heraklion University Hospital, P.O. Box 1352, 71110 Heraklion, Greece. (Email: cardio{at}med.uoc.gr).

Objectives: The purpose of this study was to assess atrial myocardial perfusion in patients with lone recurrent atrial fibrillation (LRAF).

Background: Although acute atrial ischemia has been implicated in the pathogenesis of atrial fibrillation, there are few data concerning human atrial myocardial perfusion and none for patients with LRAF.

Methods: Sixteen patients with LRAF and 15 control subjects with suitable coronary anatomy underwent time-averaged peak coronary blood flow velocity (APV) measurements (cm/s), using a Doppler guidewire in the proximal left circumflex coronary artery (LCx) and in the left atrial circumflex branch (LACB), at baseline (b) and after adenosine administration to achieve maximal hyperemia (h). Coronary flow reserve was defined as h-APV/b-APV.

Results: Although there were no statistically significant differences in b-APV between patients with LRAF and control subjects or between the LACB and LCx, there were significant group (p = 0.002), artery (p = 0.001), and interaction (p < 0.001) effects at maximal hyperemia. In patients with LRAF, the h-APV and coronary flow reserve of the LACB (30.4 ± 9.5 cm/s and 2.2 ± 0.4, respectively) were significantly lower than in the LACB of the control subjects (45.8 ± 12.8 cm/s [p < 0.001] and 2.9 ± 0.5 [p = 0.001], respectively) or in the patients' LCx (43.0 ± 10.9 cm/s [p = 0.001] and 3.1 ± 0.6 [p < 0.001], respectively).

Conclusions: This study confirms for the first time isolated atrial myocardial perfusion abnormalities in patients with LRAF and coronary flow reserve impairment, indicating that microvascular dysfunction is a pathophysiological substrate associated with this arrhythmia.

Abbreviations and Acronyms   AF = atrial fibrillation   APV = time-averaged peak coronary flow velocity   b-APV = time-averaged peak coronary flow velocity at baseline   CFR = coronary flow reserve   h-APV = time-averaged peak coronary flow velocity after maximal hyperemia   LACB = left atrial circumflex branch   LCx = left circumflex coronary artery   LRAF = lone recurrent atrial fibrillation

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J. Am. Coll. Cardiol. 2008 51: A23-A24. [Full Text] [PDF]