Atrial Stunning Following Sinus Rhythm Restoration: Which Mechanism, Time Course and Implication for Anticoagulation?

Rigo, Fausto; Raviele, Antonio; Piccoli, B. De; Caprioglio, Francesco; Zanella, C.; Cutaia, V.

doi:10.1007/978-88-470-2139-6_12

Cited by 1 publication

(5 citation statements)

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“…These include: (i) the control condition, which mimics the healthy and normal atrial tissue (state 1), as well as the tissue about 6 weeks after successful cardioversion (state 2). This assumption is reasonable as the atria normally restore their mechanical contraction about 6 weeks after successful cardioversion with atrial stunning [ 6 – 8 , 85 ]. This time period is sufficient for atrial tissue to go through reverse electrical remodeling after cardiac arrhythmias as shown in some experimental animal studies [ 86 ]; (ii) AFER-SR condition that simulates the AF-remodeled atrial tissue with normal sinus rhythm (SR) (state 3).…”

Section: Methodsmentioning

confidence: 99%

“…Atrial stunning is the loss of mechanical atrial contraction following a successful cardioversion, which is maximal immediately after cardioversion and can take up to 6 weeks for normal atrial contraction to re-establish [ 6 ]. A long period of atrial stunning may cause an increased risk of thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

“…Atrial stunning occurs rarely following spontaneous cardioversion in paroxysmal arrhythmias. Previous studies have also shown that factors delaying return of normal atrial mechanical function include duration of atrial fibrillation, presence of structural heart disease, atrial pressures and atrial size [ 6 – 8 ]. However, the exact mechanisms causing impaired atrial mechanics, as occurs in atrial stunning are unknown.…”

Section: Introductionmentioning

confidence: 99%

“…However, the exact mechanisms causing impaired atrial mechanics, as occurs in atrial stunning are unknown. Some postulated mechanisms include tachycardia induced atrial cardiomyopathy, accumulation of cytosolic calcium and atrial hibernation [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is unknown why atrial stunning occurs frequently for chronic AF but rarely for paroxysmal AF patients [ 6 – 8 ]. The intrinsic electrophysiological properties of the atria are altered during chronic AF due to the atrial fibrillation induced electrical remodelling (AFER) [ 9 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Persistent Atrial Fibrillation-Induced Electrical Remodeling on Atrial Electro-Mechanics – Insights from a 3D Model of the Human Atria

et al. 2015

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AimsAtrial stunning, a loss of atrial mechanical contraction, can occur following a successful cardioversion. It is hypothesized that persistent atrial fibrillation-induced electrical remodeling (AFER) on atrial electrophysiology may be responsible for such impaired atrial mechanics. This simulation study aimed to investigate the effects of AFER on atrial electro-mechanics.Methods and ResultsA 3D electromechanical model of the human atria was developed to investigate the effects of AFER on atrial electro-mechanics. Simulations were carried out in 3 conditions for 4 states: (i) the control condition, representing the normal tissue (state 1) and the tissue 2–3 months after cardioversion (state 2) when the atrial tissue recovers its electrophysiological properties after completion of reverse electrophysiological remodelling; (ii) AFER-SR condition for AF-remodeled tissue with normal sinus rhythm (SR) (state 3); and (iii) AFER-AF condition for AF-remodeled tissue with re-entrant excitation waves (state 4). Our results indicate that at the cellular level, AFER (states 3 & 4) abbreviated action potentials and reduced the Ca2+ content in the sarcoplasmic reticulum, resulting in a reduced amplitude of the intracellular Ca2+ transient leading to decreased cell active force and cell shortening as compared to the control condition (states 1 & 2). Consequently at the whole organ level, atrial contraction in AFER-SR condition (state 3) was dramatically reduced. In the AFER-AF condition (state 4) atrial contraction was almost abolished.ConclusionsThis study provides novel insights into understanding atrial electro-mechanics illustrating that AFER impairs atrial contraction due to reduced intracellular Ca2+ transients.

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