Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy

Vojtech Melenovsky, Ilan Hay, Barry J. Fetics, Barry A Borlaug, Andrew Kramer, Joseph M. Pastore, Ronald Berger, David A. Kass

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Aims: Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function. Methods and results: Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14-30%) were studied using a pressure-volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min-1 mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min-1, ventricular function was similar between the two pacing modes. However, at 120 min-1, irregular pacing impaired systolic (dP/dtmax: - 8.2%, P < 0.001) and diastolic function (dP/dtmin: +21%, P < 0.001, LV end-diastolic pressure: +26%, P = 0.007) compared with regular rate pacing. Contractile function during irregular pacing varied with the ratio of preceding/pre-preceding intercycle (RR) interval (dP/dtmax: 80 b.p.m.: r = 0.69; 120 b.p.m.: r = 0.74), whereas pre-load had little effect on instantaneous contractility. Conclusion: In heart failure subjects with AFib, RR-interval irregularity worsens cardiac function at elevated but not at normal range heart rate. Overall rate control is most important in these patients while rate régularisation of rapid AFib may impart additional benefits.

Original languageEnglish (US)
Pages (from-to)705-711
Number of pages7
JournalEuropean Heart Journal
Volume26
Issue number7
DOIs
StatePublished - Apr 2005
Externally publishedYes

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Cardiac Resynchronization Therapy
Atrial Fibrillation
Heart Failure
Ventricular Function
Atrioventricular Block
Tachycardia
Reference Values
Catheters
Heart Rate
Blood Pressure
Pressure

Keywords

  • Atrial fibrillation
  • Biventricular pacing
  • Heart failure
  • Physiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy. / Melenovsky, Vojtech; Hay, Ilan; Fetics, Barry J.; Borlaug, Barry A; Kramer, Andrew; Pastore, Joseph M.; Berger, Ronald; Kass, David A.

In: European Heart Journal, Vol. 26, No. 7, 04.2005, p. 705-711.

Research output: Contribution to journalArticle

Melenovsky, Vojtech ; Hay, Ilan ; Fetics, Barry J. ; Borlaug, Barry A ; Kramer, Andrew ; Pastore, Joseph M. ; Berger, Ronald ; Kass, David A. / Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy. In: European Heart Journal. 2005 ; Vol. 26, No. 7. pp. 705-711.
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abstract = "Aims: Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function. Methods and results: Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14-30{\%}) were studied using a pressure-volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min-1 mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min-1, ventricular function was similar between the two pacing modes. However, at 120 min-1, irregular pacing impaired systolic (dP/dtmax: - 8.2{\%}, P < 0.001) and diastolic function (dP/dtmin: +21{\%}, P < 0.001, LV end-diastolic pressure: +26{\%}, P = 0.007) compared with regular rate pacing. Contractile function during irregular pacing varied with the ratio of preceding/pre-preceding intercycle (RR) interval (dP/dtmax: 80 b.p.m.: r = 0.69; 120 b.p.m.: r = 0.74), whereas pre-load had little effect on instantaneous contractility. Conclusion: In heart failure subjects with AFib, RR-interval irregularity worsens cardiac function at elevated but not at normal range heart rate. Overall rate control is most important in these patients while rate r{\'e}gularisation of rapid AFib may impart additional benefits.",
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AU - Kramer, Andrew

AU - Pastore, Joseph M.

AU - Berger, Ronald

AU - Kass, David A.

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N2 - Aims: Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function. Methods and results: Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14-30%) were studied using a pressure-volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min-1 mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min-1, ventricular function was similar between the two pacing modes. However, at 120 min-1, irregular pacing impaired systolic (dP/dtmax: - 8.2%, P < 0.001) and diastolic function (dP/dtmin: +21%, P < 0.001, LV end-diastolic pressure: +26%, P = 0.007) compared with regular rate pacing. Contractile function during irregular pacing varied with the ratio of preceding/pre-preceding intercycle (RR) interval (dP/dtmax: 80 b.p.m.: r = 0.69; 120 b.p.m.: r = 0.74), whereas pre-load had little effect on instantaneous contractility. Conclusion: In heart failure subjects with AFib, RR-interval irregularity worsens cardiac function at elevated but not at normal range heart rate. Overall rate control is most important in these patients while rate régularisation of rapid AFib may impart additional benefits.

AB - Aims: Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function. Methods and results: Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14-30%) were studied using a pressure-volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min-1 mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min-1, ventricular function was similar between the two pacing modes. However, at 120 min-1, irregular pacing impaired systolic (dP/dtmax: - 8.2%, P < 0.001) and diastolic function (dP/dtmin: +21%, P < 0.001, LV end-diastolic pressure: +26%, P = 0.007) compared with regular rate pacing. Contractile function during irregular pacing varied with the ratio of preceding/pre-preceding intercycle (RR) interval (dP/dtmax: 80 b.p.m.: r = 0.69; 120 b.p.m.: r = 0.74), whereas pre-load had little effect on instantaneous contractility. Conclusion: In heart failure subjects with AFib, RR-interval irregularity worsens cardiac function at elevated but not at normal range heart rate. Overall rate control is most important in these patients while rate régularisation of rapid AFib may impart additional benefits.

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