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Lyon, A; van Mourik, M; Cruts, L; Heijman, J; Bekkers, SCAM; Schotten, U; Crijns, HJGM; Linz, D; Lumens, J.
Both beat-to-beat changes in RR-interval and left ventricular filling time determine ventricular function during atrial fibrillation
EUROPACE. 2021; 23: I21-I28. Doi: 10.1093/europace/euaa387 [OPEN ACCESS]
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Co-authors Med Uni Graz: Heijman Jordi
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Abstract:: Aims The irregular atrial electrical activity during atrial fibrillation (AF) is associated with a variable left ventricular (LV) systolic function. The mechanisms determining LV function during AF remain incompletely understood. We aimed at elucidating how changes in RR-interval and LV preload affect LV function during AF. Methods and results Beat-to-beat speckle-tracking echocardiography was performed in 10 persistent AF patients. We evaluated the relation between longitudinal LV peak strain and preceding RR-interval during AF. We used the CircAdapt computational model to evaluate beat-to-beat preload and peak strain during AF for each patient by imposing the patient-specific RR-interval sequences and a non-contractile atrial myocardium. Generic simulations with artificial RRinterval sequences quantified the haemodynamic changes induced by sudden irregular beats. Clinical data and simulations both showed a larger sensitivity of peak strain to changes in preceding RR-interval at slow heart rate (HR) (cycle length, CL <750 ms) than at faster HR. Simulations explained this by a difference in preload of the current beat. Generic simulations confirmed a larger sensitivity of peak strain to preceding RR-interval at fast HR (CL = 600 ms: Delta peak strain = 3.7% vs. 900 ms: Delta peak strain = 0.3%) as in the patients. They suggested that longer LV activation with respect to preceding RR-interval is determinant for this sensitivity. Conclusions During AF, longitudinal LV peak strain is highly variable, particularly at fast HR. Beat-to-beat changes in preload explain the differences in LV systolic function. Simulations revealed that a reduced diastolic LV filling time can explain the increased variability at fast HR.
Find related publications in this database (Keywords): Atrial fibrillation; Speckle-tracking echocardiography; Left ventricular function; Computer simulations; Haemodynamics