Evidence of mechanoelectric feedback in the atria of patients with atrioventricular nodal reentrant tachycardia

Manios, Emmanuel G.; Mavrakis, Hercules E.; Kanoupakis, Emmanuel M.; Kallergis, Eleftherios M.; Kafarakis, P; Vardas, Panos

doi:10.1007/s10840-006-9019-3

Cited by 6 publications

(1 citation statement)

References 22 publications

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“…This response has been termed atrial mechanoelectric feedback [4]. Similar changes have been described during acute pressure elevation by some [5][6][7] but not by others [8][9][10] in the human right atrium. However, the relation between atrial pressure and ERP has not been studied in the human left atrium (LA), the major source of AF.…”

Section: Introductionmentioning

confidence: 70%

Impaired adaptation to left atrial pressure increase in patients with atrial fibrillation

Ágoston

Szilágyi

Bencsik

et al. 2015

J Interv Card Electrophysiol

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Background or purpose Episodes of left atrial (LA) pressure increase predispose to atrial fibrillation (AF). The adaptation of LA mechanical function and electrophysiology to pressure elevation in healthy adults, and in patients with AF, is largely unknown. Methods Eleven patients with left-sided accessory pathway (controls) and 16 patients with paroxysmal AF undergoing catheter ablation were studied. LA pressure (LAP) was recorded through transseptal catheterization, while speckle trackingderived peak LA longitudinal strain (PALS) was measured using transthoracic echocardiography. Stiffness index (SI) was calculated as mean LAP/PALS. Effective refractory period (ERP) of the LA was determined during simultaneous atrioventricular (AV) pacing and during atrial pacing. Results At baseline, AF patients had higher LA pressure (mean LAP 8.3±4.7 vs. 5.1±3.1 mmHg, p=0.048), reduced LA mechanical function (PALS 15.1±5.1 vs. 21.6±6.2 %, p=0.006, SI 0.69±0.75 vs. 0.28±0.22, p=0.015), and longer LA ERP (242.3±33.4 vs. 211.7±15.6 ms, p=0.017). Mean LAP was increased to the same extent by AV pacing in controls and AF patients (mean change 12.6± 7.4 vs. 12.6± 7.5 mmHg, p=0.980). At the same time PALS decreased (from 15.1±5.1 to 11.6±3.3 %, p=0.008), SI increased (from 0.69±0.75 to 1.29±1.17, p<0.001) and ERP shortened (from 242.3±33.4 to 215.9±26.3 ms, p=0.003) in AF patients, while they remained unchanged in controls. ConclusionsThe stiffened LA in patients with AF responds to acute pressure elevation with an exaggerated increase in wall tension and decrease in ERP, which is not seen in the normal LA. This may underlie the propensity for AF during episodes of atrial stretch in these patients.

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