Key result
In patients with atrial fibrillation, the non-invasive volume-clamp method accurately measured beat-to-beat blood pressure compared to intra-arterial measurements, with a mean systolic difference of -4 mmHg.
Why the study?
Does non-invasive beat-to-beat blood pressure measurement using the volume-clamp method accurately reflect intra-arterial blood pressure in patients with atrial fibrillation?
Observational (n=41)
Yes
Does non-invasive beat-to-beat blood pressure measurement using the volume-clamp method accurately reflect intra-arterial blood pressure in patients with atrial fibrillation?
Mean Difference: -4
Absolute Event Rate: 111% vs 115%
The volume-clamp method provides accurate non-invasive beat-to-beat measurement of diastolic and mean blood pressure, as well as beat-to-beat variability, in patients with atrial fibrillation, though systolic blood pressure precision remains suboptimal.
VCM may enable accurate beat-to-beat BP assessment in AF; leaves open validation and clinical adoption pending larger studies.
International guidelines highlight the importance of blood pressure (BP) in patients with atrial fibrillation (AF). However, BP measurement in AF is complicated by beat-to-beat fluctuation. Automated BP measurement devices are not validated for patients with AF and no consensus exists on how to measure BP in AF manually. Beat-to-beat BP measurement using the volume-clamp method (VCM) could represent a non-invasive method to accurately assess BP, but has not been validated in AF. 31 admitted patients with sustained AF and 10 control patients with sinus rhythm underwent simultaneous intra-arterial and non-invasive BP measurement using a VCM monitor (Nexfin ® , BMEYE, Amsterdam, The Netherlands). Patients with compromised peripheral perfusion, high doses of vasopressor drugs or peripheral edema were excluded. Differences in systolic, diastolic and mean BP of 5 (standard deviation; SD 8) mmHg (accuracy and precision) between both methods were considered acceptable. Additionally, the magnitude of beat-to-beat fluctuations in systolic BP of both methods was compared. In AF, the differences between noninvasive and invasive BP were −4 (SD 12), +1 (SD 7) and 0 (SD 8) mmHg for systolic, diastolic and mean BP respectively. Absolute differences in beat-to-beat BP fluctuations were 1.5 (IQR 0.8–3.8) mmHg. Accuracy of VCM in AF was similar to sinus rhythm. In conclusion, in patients with AF, accurate and precise measurement of non-invasive beat-to-beat BP measurement using the VCM is possible, the one exception being the precision of systolic BP. Beat-to-beat variability can be accurately reproduced.
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Berkelmans et al. (2017) conducted an observational in Atrial fibrillation (n=41). Volume-clamp method (VCM) vs. Intra-arterial blood pressure measurement was evaluated on Mean difference in systolic blood pressure between VCM and intra-arterial measurement in patients with atrial fibrillation (MD -4 mmHg). In patients with atrial fibrillation, the non-invasive volume-clamp method accurately measured beat-to-beat blood pressure compared to intra-arterial measurements, with a mean systolic difference of -4 mmHg.
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