The hemodynamic consequences of cardiac arrhythmias: Evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model

Naito, Masahito; David, Daniel; Michelson, Eric L.; Schaffenburg, Mark; Dreifus, Leonard S.

doi:10.1016/0002-8703(83)90194-1

Cited by 203 publications

(107 citation statements)

References 32 publications

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“…Hemodynamic impairment due to variation in R-R intervals during AF has been demonstrated in a canine model with complete heart block, in which cardiac output fell by approximately 9% during irregular ventricular pacing at the same mean cycle length as a regularly paced rhythm. 182 In patients undergoing AV nodal ablation, irregular right ventricular (RV) pacing at the same rate as regular ventricular pacing resulted in a 15% reduction in cardiac output. 183 Myocardial contractility is not constant during AF because of force-interval relationships associated with variations in cycle length.…”

Section: Myocardial and Hemodynamic Consequences Of Atrial Fibrillationmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,877

589

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Section: Myocardial and Hemodynamic Consequences Of Atrial Fibrillationmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,877

589

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“…AF contributes to decline of left ventricular systolic and diastolic function over time (32,33), which may promote progression of CKD through altered cardiac hemodynamics (33,34). Animal studies have also suggested that AF may directly and adversely affect renal hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Risk of ESRD in Adults with CKD

Bansal¹,

Xie²,

Tao³

et al. 2016

CJASN

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Background and objectives Atrial fibrillation frequently complicates CKD and is associated with adverse outcomes. Progression to ESRD is a major complication of CKD, but the link with atrial fibrillation has not been fully delineated. In this study, we examined the association of incident atrial fibrillation with the risk of ESRD in patients with CKD.Design, setting, participants, & measurements We studied participants in the prospective Chronic Renal Insufficiency Cohort Study without atrial fibrillation at entry. Incident atrial fibrillation was identified by study visit ECGs, self-report, and hospital discharge diagnostic codes, with confirmation by physician adjudication. ESRD through 2012 was ascertained by participant self-report, medical records, and linkage to the US Renal Data System. Data on potential confounders were obtained from self-report, study visits, and laboratory tests. Marginal structural models were used to study the potential association of incident atrial fibrillation with risk of ESRD after adjustment for time-dependent confounding.Results Among 3091 participants, 172 (5.6%) developed incident atrial fibrillation during follow-up. During mean follow-up of 5.9 years, 43 patients had ESRD that occurred after development of incident atrial fibrillation (11.8/ 100 person-years) compared with 581 patients without incident atrial fibrillation (3.4/100 person-years). In marginal structural models with inverse probability weighting, incident atrial fibrillation was associated with a substantially higher rate of ESRD (hazard ratio, 3.2; 95% confidence interval, 1.9 to 5.2). This association was consistent across important subgroups by age, sex, race, diabetes status, and baseline eGFR.Conclusions Incident atrial fibrillation was associated with higher risk of developing ESRD in CKD. Additional study is needed to identify potentially modifiable pathways through which atrial fibrillation was associated with a higher risk of progression to ESRD. More aggressive monitoring and treatment of patients with CKD and atrial fibrillation may improve outcomes in this high-risk population.

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“…Multiple mechanisms are responsible for the detrimental hemodynamic consequences during AF. These include the increase in heart rate, the loss of atrial contribution to ventricular filling, the reduced interval for passive diastolic filling, and the irregular ventricular rhythm (3,7,9,15,24,26,33,35,40). Clinically, VR slowing is considered to be the first therapeutic step in a majority of patients with both acute and chronic AF (16).…”

Section: Discussionmentioning

confidence: 99%

Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation

Zhang

Mowrey

Zhuang

et al. 2002

American Journal of Physiology-Heart and Circulatory Physiology

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The hemodynamic consequences of cardiac arrhythmias: Evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model

Cited by 203 publications

References 32 publications

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Atrial Fibrillation and Risk of ESRD in Adults with CKD

Optimal ventricular rate slowing during atrial fibrillation by feedback AV nodal-selective vagal stimulation

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