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Arterial stiffness and atrial fibrillation: shared mechanisms, clinical implications and therapeutic options. J Hypertens 2022; 40:1639-1646. [PMID: 35943096 DOI: 10.1097/hjh.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Arterial stiffness (AS) and atrial fibrillation (AF) share commonalities in molecular and pathophysiological mechanisms and numerous studies have analyzed their reciprocal influence. The gold standard for AS diagnosis is represented by aortic pulse wave velocity, whose measurement can be affected by arrhythmias characterized by irregularities in heart rhythm, such as AF. Growing evidence show that patients with AS are at high risk of AF development. Moreover, the subset of AF patients with AS seems to be more symptomatic and rhythm control strategies are less effective in this population. Reducing AS through de-stiffening interventions may be beneficial for patients with AF and can be a new appealing target for the holistic approach of AF management. In this review, we discuss the association between AS and AF, with particular interest in shared mechanisms, clinical implications and therapeutic options.
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Hermans ANL, Pluymaekers NAHA, Lankveld TAR, van Mourik MJW, Zeemering S, Dinh T, den Uijl DW, Luermans JGLM, Vernooy K, Crijns HJGM, Schotten U, Linz D. Clinical utility of rhythm control by electrical cardioversion to assess the association between self-reported symptoms and rhythm status in patients with persistent atrial fibrillation. IJC HEART & VASCULATURE 2021; 36:100870. [PMID: 34568541 PMCID: PMC8449169 DOI: 10.1016/j.ijcha.2021.100870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/27/2021] [Accepted: 09/05/2021] [Indexed: 11/05/2022]
Abstract
Background The best strategy to assess the association between symptoms and rhythm status (symptom-rhythm correlation) in patients with atrial fibrillation (AF) remains unclear. We aimed to determine the clinical utility of rhythm control by electrical cardioversion (ECV) to assess symptom-rhythm correlation in patients with persistent AF. Methods We used ECV to examine symptom-rhythm correlation in 81 persistent AF patients. According to current clinical practice, the presence of self-reported symptoms before ECV and at the first outpatient clinic follow-up visit (within 1-month) was assessed to determine the prevalence of a symptom-rhythm correlation (defined as self-reported symptoms present during AF and absent in sinus rhythm or absent in AF and yet relief during sinus rhythm). In addition, we evaluated symptom patterns around ECV. Results Only in 18 patients (22%), a symptom-rhythm correlation could be documented. Twenty-eight patients (35%) did not show any symptom-rhythm correlation and 35 patients (43%) had an unevaluable symptom-rhythm correlation as these patients were in symptomatic AF both at baseline and at the first outpatient AF clinic follow-up visit. Importantly, self-reported symptom patterns around ECV were intra-individually variable in 10 patients (12%) without symptom-rhythm correlation (of which 9 patients (11%) had AF recurrence) and in 2 patients (2%) with an unevaluable symptom-rhythm correlation. Conclusions In patients with persistent AF, symptom assessment around rhythm control by ECV, once before ECV and once within 1-month follow-up, rarely identifies a symptom-rhythm correlation and often suggests changes in symptom pattern. Better strategies are needed to assess symptom-rhythm correlation in patients with persistent AF.
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Affiliation(s)
- Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Theo A R Lankveld
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Manouk J W van Mourik
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Stef Zeemering
- Department of Physiology, Maastricht University and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Trang Dinh
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.,Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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