Effect of restoring sinus rhythm in hypertensive patients with atrial fibrillation undergoing electrical cardioversion

Maselli, Monica; Giantin, Valter; Franchin, Alessandro; Attanasio, Francesca; Tramontano, Alessandra; Toni, Pietro De; Pengo, V.; Corrado, Domenico; Manzato, Enzo

doi:10.1097/mbp.0000000000000211

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…As compared to sinus rhythm, we observed slightly lower systolic BP and slightly higher diastolic BP values in assumed AF, rendering PP values to be dependent on rhythm in this study using intraindividual comparisons. This is in line with our previous findings comparing patients with high likelihood of AF to individuals with low likelihood of AF [ 22 ] and other studies with intraindividual comparisons [ 13 , 14 ]. However, those studies [ 13 , 14 ] did not compare averaged BP values in adjacent episodes of AF and normal rhythm during an ABPM as we did in the current study.…”

Section: Discussionsupporting

confidence: 93%

“…BP may change during AF, as compared to SR, due to hemodynamic alterations. Some studies comparing BP in AF and in SR in the same subjects before and after direct current cardioversion to restore SR suggest a trend for higher systolic and lower diastolic BP in SR [ 13 – 16 ]. However, results are inconsistent, study populations were small, and comparisons were not made to intra-arterial BP.…”

Section: Introductionmentioning

confidence: 99%

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Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Lundwall,

Kahan,

Omboni

2023

Hypertens Res

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The coexistence of hypertension and atrial fibrillation (AF) is common and accounts for a worse prognosis. Uncertainties exist regarding blood pressure (BP) measurements in AF patients by automated oscillometric devices. The Microlife WatchBP 03 AFIB ambulatory BP monitoring (ABPM) device including an AF algorithm with each measurement was used in 430 subjects aged >65 years referred for ABPM and with assumed paroxysmal AF to perform intra-individual comparisons of BP during both AF-indicated and sinus rhythm. Only subjects with >30% of measurements indicating AF and episodes >30 min for assumed AF and for sinus rhythm were included. Mean age was 78 ± 7 years, 43% were male, 77% hypertensive, and 72% were treated. Compared to sinus rhythm, 24-h mean arterial pressure was similar (87.2 ± 9.5 vs 87.5 ± 10.6 mm Hg, p = 0.47), whereas 24-h systolic BP tended to be lower (123.6 ± 13.9 vs 124.7 ± 16.1 mm Hg, p = 0.05) and night-time diastolic BP higher (64.6 ± 10.9 vs 63.3 ± 10.4 mm Hg, p = 0.01) in assumed AF. Diastolic (not systolic) BP variability was higher in AF (p < 0.001). Results were similar with heart rates <90 and ≥90 bpm. In conclusion, this is the first study to use intra-individual comparisons of averaged BP during an ABPM in assumed paroxysmal AF and sinus rhythm. Our results imply that ABPM is feasible and informative also in patients with AF. We also suggest that an AF detection algorithm offers a new approach to evaluate the reliability of averaged BP values in AF compared to SR during an ABPM.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Lundwall,

Kahan,

Omboni

2023

Hypertens Res

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“…This effect was also noted in our study collective: an overall increase of systolic iBP of 5.6 mmHg was achieved during the 2h-observational-period after having administered Vernakalant. Although conflicting results about how and when exactly restoration of SR can increase BP-values, one theory is the atrial contractility being increased and therefore a greater ejection fraction resulting from the left ventricle 32 . Comparing Vernakalant to other antiarrhythmic agents such as Ibutilide 19 , the slight and immediate effect of BP-increase could be a distinct feature of Vernakalant and not just related to the cardioversion itself.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation

Schnaubelt

Niederdöckl

Simon

et al. 2020

Sci Rep

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Postoperative atrial fibrillation (POAF) is one of the most frequent complications after cardiothoracic surgery and a predictor for postoperative mortality and prolonged ICU-stay. Current guidelines suggest the multi-channel inhibitor Vernakalant as a treatment option for rhythm control. However, rare cases of severe hypotension and cardiogenic shock following drug administration have been reported. To elucidate the impact of Vernakalant on hemodynamics, we included ten ICU patients developing POAF after elective cardiac surgery, all of them awake and breathing spontaneously, in this prospective trial. Patients received the recommended dosage of Vernakalant and were clinically observed and monitored (heart rate, invasive blood pressure, pulse oximetry, central venous pressure) in 1-minute-intervals for 20 minutes before-and 120 minutes after the first dose of Vernakalant. The median time from the end of surgery until occurrence of POAF amounted up to 52.8 [45.9-77.4] hours, it took 3.5 [1.2-10.1] hours from occurrence of POAF until the first application of Vernakalant. All patients received catecholamine support with epinephrine that was held steady and not dynamic throughout the observational phase. We noted stable hemodynamic conditions, with a trend towards a reduction in heart rate throughout the 120 minutes after drug administration. In 7 patients (70%), conversion to sustained sinus rhythm (SR) occurred within 8.0 minutes [6.0-9.0]. No serious adverse events (SAEs) were noted during the observation period. In this prospective trial in ICU-patients showing POAF after cardiac surgery, intravenous Vernakalant did not induce clinically relevant negative effects on patients' hemodynamics but resulted in conversion to sustained SR after a median of 8.0 minutes in 7 out of ten patients.Postoperative atrial fibrillation (POAF) typically occurs around the second postoperative day and shows an especially high incidence of 40-60% in individuals undergoing cardio-surgical procedures. It represents a strong contributor for major cardiac adverse events in the short and the long run 1 . Recent evidence shows that POAF is linked to one third of postoperative strokes 1 . Moreover, POAF leads to complications such as ventricular arrythmias, congestive heart failure, the need for permanent pacemaker implantation, prolonged mechanical ventilation and ICU-stay, an increased risk for infection 1,2 , and is even associated with increased overall and cardiovascular mortality 3 . Various factors such as local inflammation, sympathetic activation or electrolyte imbalances have been discussed as etiologic factors for POAF development 4,5 . Whereas in severely symptomatic or hemodynamically unstable patients SR restoration by electrical cardioversion is persecuted, early pharmacologic cardioversion 6-8 to prevent complications seems reasonable in the remaining patients, although POAF is often transient and self-limiting 9 . Hence, the relatively atrial selective and rate-dependent multi-channel-inhibitor Vernakalant has been recommend...

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“…A decrease in diastolic BP of 5 mm Hg and, in line with our results, an increase in systolic BP of 4‐5 mm Hg following cardioversion were observed. Another study by Maselli et al included 54 hypertensive patients with persistent AF undergoing DC cardioversion. BP was evaluated with ambulatory BP on the day before and about a month after cardioversion.…”

Section: Discussionmentioning

confidence: 99%

Systolic blood pressure increases in patients with atrial fibrillation regaining sinus rhythm after electrical cardioversion

Olbers

Jacobson

Viberg

et al. 2019

J of Clinical Hypertension

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Direct current (DC) cardioversion is used to convert persistent atrial fibrillation (AF) to sinus rhythm (SR), but there is limited knowledge about how blood pressure (BP) is affected by conversion to SR. We sought to evaluate how BP changed in AF patients who converted to SR, compared to patients still in AF. In this retrospective registry analysis, we included a total of 487 patients, treated with DC cardioversion for persistent AF. We obtained data regarding medical history, medication, BP, and electrocardiogram the day before and 7 days after cardioversion. Systolic BP increased by 9 (±16) mm Hg (P < 0.01) and diastolic BP decreased by 3 (±9) mm Hg (P < 0.01) after conversion to SR. In the group of patients with restored SR, there was a 40% increase in the proportion of patients with a hypertensive BP level (≥140/90 mm Hg) after DC cardioversion compared to before. Patients still in AF had no significant change in BP. Systolic BP increases and diastolic BP slightly decreases when persistent AF is converted to SR. The underlying mechanisms explaining these findings are not known, but may involve either hemodynamic changes that occur when SR is restored, an underestimation of systolic BP in AF, or a combination of both. Our findings suggest that an increased attention to BP levels after a successful cardioversion is warranted.

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Effect of restoring sinus rhythm in hypertensive patients with atrial fibrillation undergoing electrical cardioversion

Cited by 7 publications

References 17 publications

Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation

Systolic blood pressure increases in patients with atrial fibrillation regaining sinus rhythm after electrical cardioversion

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