Induced atrial fibrillation significantly decreased right ventricular end-diastolic pressure (P=0.016) and systolic pressure (P=0.001), and increased diastolic blood pressure (P=0.02).
RCT (n=42)
2:1
No
Does atrial fibrillation induction alter intracardiac and systemic blood pressures in patients eligible for catheter ablation?
Induced atrial fibrillation acutely decreases right ventricular pressures and increases diastolic blood pressure, providing a haemodynamic rationale for rhythm control strategies.
p-value: p=0.016 for RVEDP; 0.001 for RVSP; 0.02 for DBP
Abstract Aims Atrial fibrillation (AF) haemodynamics is less well studied due to challenges explained by the nature of AF. Until now, no randomized data are available. This study evaluates haemodynamic variables after AF induction in a randomized setting. Methods and results Forty-two patients with AF who had been referred for ablation to the University Hospital, Linköping, Sweden, and had no arrhythmias during the 4-day screening period were randomized to AF induction vs. control (2:1). Atrial fibrillation was induced by burst pacing after baseline intracardiac pressure measurements. Pressure changes in the right and left atrium (RA and LA), right ventricle (RV), and systolic and diastolic blood pressures (SBP and DBP) were evaluated 30 min after AF induction compared with the control group. A total of 11 women and 31 men (median age 60) with similar baseline characteristics were included (intervention n = 27, control group n = 15). After 30 min in AF, the RV end-diastolic pressure (RVEDP) and RV systolic pressure (RVSP) significantly reduced compared with baseline and between randomization groups (RVEDP: P = 0.016; RVSP: P = 0.001). Atrial fibrillation induction increased DBP in the intervention group compared with the control group (P = 0.02), unlike reactions in SBP (P = 0.178). Right atrium and LA mean pressure (RAm and LAm) responses did not differ significantly between the groups (RAm: P = 0.307; LAm: P = 0.784). Conclusion Induced AF increased DBP and decreased RVEDP and RVSP. Our results allow us to understand some paroxysmal AF haemodynamics, which provides a haemodynamic rationale to support rhythm regulatory strategies to improve symptoms and outcomes. Trial registration number (clinicaltrials.gov) No NCT01553045. https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1
Almroth et al. (Tue,) conducted a rct in Atrial fibrillation (n=42). Atrial fibrillation induction by burst pacing vs. Control was evaluated on Pressure changes in the right and left atrium, right ventricle, and systolic and diastolic blood pressures 30 min after AF induction (p=0.016 for RVEDP; 0.001 for RVSP; 0.02 for DBP). Induced atrial fibrillation significantly decreased right ventricular end-diastolic pressure (P=0.016) and systolic pressure (P=0.001), and increased diastolic blood pressure (P=0.02).