Restoring Sinus Rhythm Improves Baroreflex Function in Patients With Persistent Atrial Fibrillation

Abstract

BackgroundStudies have suggested that patients with atrial fibrillation (AF) have impairment in the baroreflex. It is not clear whether these findings are the result of the associated comorbid conditions or the arrhythmia itself. We hypothesized that AF is associated with impairment in baroreflex function and that the arrhythmia itself is a contributing factor.Methods and ResultsTwenty‐four patients with persistent AF referred for cardioversion were enrolled. A second group of patients with no history of AF matched for age and left ventricular ejection fraction was identified and served as the control group. In the AF group, baroreflex gain (BRG) was measured on the day of cardioversion (Day 1) and again at 30 days post‐cardioversion (Day 30) in patients who remained in sinus rhythm (SR). The clinical characteristics of patients with AF were not different than those of the control group. The mean BRG in the AF group on Day 1 was significantly lower than the mean BRG of the control group (5.2±3.6 versus 10.8±5.5 ms/mm Hg, P<0.05). Ten patients experienced AF recurrence before the 30‐day follow‐up and 14 patients remained in SR. In the group that remained in SR, BRG increased from 4.1±3.7 ms/mm Hg on Day 1 to 7.0±6.0 ms/mm Hg on Day 30 (P<0.01).ConclusionWe have shown that AF is associated with impairment of the baroreflex and that restoration of SR improves BRG. Our data suggest that AF might be a contributing factor to the observed impairment in BRG and that restoring SR might help improve baroreflex function.

Safety and feasibility of retrograde INOUE-BALLOON for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve replacement

“…The contribution of the atrial kick depends on the heart rate and heart structure. During tachycardia, the ventricular diastole period is reduced leading to increased dependence of the [19]. In addition, a long RVP time may also prolong the time of myocardial blood flow reduction and delay myocardial recovery after RVP.…”

“…Therefore, patients with AS might be more likely to have prolonged hypotension immediately after RVP. Furthermore, recent studies suggest that AF is associated with impaired baroreflex and that restoration of sinus rhythm improves baroreflex gain [ 19 ]. In addition, a long RVP time may also prolong the time of myocardial blood flow reduction and delay myocardial recovery after RVP.…”

Contribution of Baroreceptor Function to Pain Perception and Perioperative Outcomes

“…Perioperative Baroreceptor Reflex Function heart failure, 173,174 coronary artery disease, 25 and atrial fibrillation. 175 Baroreflex function has also been implicated in modulating muscle tone, 62 sensorimotor performance, 176 startle reflex, 177 cortical activity, 3 sleep, 178 cognitive performance, [179][180][181][182] and cortical arousal. 80 Of note, about 50% of cardiac surgery patients 183,184 and up to 26% of elderly noncardiac surgery patients 185 experience early postoperative cognitive dysfunction, which can persist in the long-term, significantly diminishing quality of life.…”

Effectiveness of heart rate control on hemodynamics in critically ill patients with atrial tachyarrhythmias managed by amiodarone

“…AT, if persistent and rapid, can lead to tachycardia-induced cardiomyopathy with heart failure [3] . This condition is reversible, either by HR or rhythm control.…”

“…AT are often associated with a ventricular heart rate (HR) above 120-130 beats per minute (bpm) which contributes to baroreflex impairment, [3] diastolic dysfunction and may lead to cardiac systolic dysfunction. Such induced ventricular tachycardiomyopathy is associated with hemodynamic instability and increased morbidity or mortality [2,4,5] .…”