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Magajevski AS, Távora‐Mehta MZP, Mehta N, Maluf DLS, Silva ECP, Concato L, Ortiz MR, Doubrawa E, Lofrano‐Alves MS. Differential hemodynamic adaptations to tilt test in patients with idiopathic atrial fibrillation. Physiol Rep 2024; 12:e16131. [PMID: 38942728 PMCID: PMC11213645 DOI: 10.14814/phy2.16131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/29/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024] Open
Abstract
The hemodynamic response during the transition from the supine to standing position in idiopathic atrial fibrillation (AF) patients is not completely understood. This study aimed to analyze the hemodynamic changes that occur during the head-up tilt test in idiopathic AF patients. We investigated the hemodynamic changes during the head-up tilt test with impedance cardiography in 40 AF patients (12 with AF rhythm-AFr and 28 with sinus rhythm-AFsr) and 38 non-AF controls. Patients with AFr had attenuated SVI decrease after standing when compared to AFsr and non-AF [ΔSVI in mL/m2: -1.3 (-3.4 to 1.7) vs. -6.4 (-17.3 to -0.1) vs. -11.8 (-18.7 to -8.0), respectively; p < 0.001]. PVRI decreased in AFr but increased in AFsr and non-AF [ΔPVRI in dyne.seg.m2/cm5: -477 (-1148 to 82.5) vs. 131 (-525 to 887) vs. 357 (-29 to 681), respectively; p < 0.01]. Similarly, compared with non-AF patients, AFr patients also had a greater HR and greater CI increase after standing. The haemodynamic response to orthostatic challenge suggests differential adaptations between patients with AF rhythm and those reverted to sinus rhythm or healthy controls. Characterizing the hemodynamic phenotype may be relevant for the individualized treatment of AF patients.
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Affiliation(s)
- Adriano Senter Magajevski
- Post Graduate Program in Internal Medicine, Internal Medicine DepartmentFederal University of ParanaCuritibaParanaBrazil
- Cardiac Electrophysiology Service of ParanaCuritibaParanaBrazil
| | - Maria Zildany P. Távora‐Mehta
- Post Graduate Program in Internal Medicine, Internal Medicine DepartmentFederal University of ParanaCuritibaParanaBrazil
- Cardiac Electrophysiology Service of ParanaCuritibaParanaBrazil
| | - Niraj Mehta
- Post Graduate Program in Internal Medicine, Internal Medicine DepartmentFederal University of ParanaCuritibaParanaBrazil
- Cardiac Electrophysiology Service of ParanaCuritibaParanaBrazil
| | | | | | - Leticia Concato
- Cardiac Electrophysiology Service of ParanaCuritibaParanaBrazil
| | | | | | - Marco Stephan Lofrano‐Alves
- Post Graduate Program in Internal Medicine, Internal Medicine DepartmentFederal University of ParanaCuritibaParanaBrazil
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Saiz-Vivo J, Abdollahpur M, Mainardi LT, Corino VDA, De Melis M, Hatala R, Sandberg F. Heart rate characteristic based modelling of atrial fibrillatory rate using implanted cardiac monitor data. Physiol Meas 2023; 44. [PMID: 36787645 DOI: 10.1088/1361-6579/acbc08] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/14/2023] [Indexed: 02/16/2023]
Abstract
Objective. The objective of the present study is to investigate the feasibility of using heart rate characteristics to estimate atrial fibrillatory rate (AFR) in a cohort of atrial fibrillation (AF) patients continuously monitored with an implantable cardiac monitor. We will use a mixed model approach to investigate population effect and patient specific effects of heart rate characteristics on AFR, and will correct for the effect of previous ablations, episode duration, and onset date and time.Approach. The f-wave signals, from which AFR is estimated, were extracted using a QRST cancellation process of the AF episodes in a cohort of 99 patients (67% male; 57 ± 12 years) monitored for 9.2(0.2-24.3) months as median(min-max). The AFR from 2453 f-wave signals included in the analysis was estimated using a model-based approach. The association between AFR and heart rate characteristics, prior ablations, and episode-related features were modelled using fixed-effect and mixed-effect modelling approaches.Main results. The mixed-effect models had a better fit to the data than fixed-effect models showing h.c. of determination (R2 = 0.49 versusR2 = 0.04) when relating the variations of AFR to the heart rate features. However, when correcting for the other factors, the mixed-effect model showed the best fit (R2 = 0.04). AFR was found to be significantly affected by previous catheter ablations (p< 0.05), episode duration (p< 0.05), and irregularity of theRRinterval series (p< 0.05).Significance. Mixed-effect models are more suitable for AFR modelling. AFR was shown to be faster in episodes with longer duration, less organizedRRintervals and after several ablation procedures.
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Affiliation(s)
- Javier Saiz-Vivo
- Medtronic: Bakken Research Center, Maastricht, The Netherlands.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Luca T Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Valentina D A Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Cardiotech Lab, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mirko De Melis
- Medtronic: Bakken Research Center, Maastricht, The Netherlands
| | - Robert Hatala
- Department of Cardiology and Angiology, Division of Arrhythmias and Cardiac Pacing, National Institute of Cardiovascular Diseases and Slovak Medical University, Bratislava, Slovakia
| | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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Plappert F, Wallman M, Abdollahpur M, Platonov PG, Östenson S, Sandberg F. An atrioventricular node model incorporating autonomic tone. Front Physiol 2022; 13:976468. [PMID: 36187793 PMCID: PMC9520409 DOI: 10.3389/fphys.2022.976468] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
The response to atrial fibrillation (AF) treatment is differing widely among patients, and a better understanding of the factors that contribute to these differences is needed. One important factor may be differences in the autonomic nervous system (ANS) activity. The atrioventricular (AV) node plays an important role during AF in modulating heart rate. To study the effect of the ANS-induced activity on the AV nodal function in AF, mathematical modelling is a valuable tool. In this study, we present an extended AV node model that incorporates changes in autonomic tone. The extension was guided by a distribution-based sensitivity analysis and incorporates the ANS-induced changes in the refractoriness and conduction delay. Simulated RR series from the extended model driven by atrial impulse series obtained from clinical tilt test data were qualitatively evaluated against clinical RR series in terms of heart rate, RR series variability and RR series irregularity. The changes to the RR series characteristics during head-down tilt were replicated by a 10% decrease in conduction delay, while the changes during head-up tilt were replicated by a 5% decrease in the refractory period and a 10% decrease in the conduction delay. We demonstrate that the model extension is needed to replicate ANS-induced changes during tilt, indicating that the changes in RR series characteristics could not be explained by changes in atrial activity alone.
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Affiliation(s)
- Felix Plappert
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- *Correspondence: Felix Plappert,
| | - Mikael Wallman
- Department of Systems and Data Analysis, Fraunhofer-Chalmers Centre, Gothenburg, Sweden
| | | | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Sten Östenson
- Department of Internal Medicine and Department of Clinical Physiology, Central Hospital Kristianstad, Kristianstad, Sweden
| | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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Malhotra V, Thakare AE, Hulke SM, Wakode SL, Parashar R, Ravi N. Effect of head down tilt on heart rate variability. J Family Med Prim Care 2021; 10:439-442. [PMID: 34017767 PMCID: PMC8132816 DOI: 10.4103/jfmpc.jfmpc_1642_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 12/01/2022] Open
Abstract
Context: Sirshasan is supposed to increase blood flow to the brain and considered to be beneficial for intellectual function, however mastering these techniques may be difficult. Aims: To see the effect of headstand using a tilt table on heart rate variability (HRV). Settings and Design: A cross-sectional study that was done on 26 healthy volunteers. Methods and Material: HRV was assessed in the supine position and 30° head tilt position for 5 min. HRV recording was done on the power lab (AD Instruments P Ltd, Castle Hill Australia). The tilt table used was Medica Podium, New Delhi, HLT-200. Statistical analysis used: Paired t-test. Results: All the HRV parameters showed non-significant change except low-frequency parameters which showed significant change during head tilt. Conclusions: Headstand to a 30° using tilt table cause a decrease in the autonomic activity which is mainly because of decrease in sympathetic activity.
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Affiliation(s)
- Varun Malhotra
- Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Sandip M Hulke
- Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Rachna Parashar
- Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Naveen Ravi
- Department of Physiology, AIIMS, Bhopal, Madhya Pradesh, India
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Patel HC, Hayward C, Wardle AJ, Middleton L, Lyon AR, Di Mario C, Salukhe TV, Sutton R, Rosen SD. The effect of head-up tilt upon markers of heart rate variability in patients with atrial fibrillation. Ann Noninvasive Electrocardiol 2017; 23:e12511. [PMID: 29034583 DOI: 10.1111/anec.12511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart rate variability (HRV) analysis is uncommonly undertaken in patients with atrial fibrillation (AF) due to an assumption that ventricular response is random. We sought to determine the effects of head-up tilt (HUT), a stimulus known to elicit an autonomic response, on HRV in patients with AF; we contrasted the findings with those of patients in sinus rhythm (SR). METHODS Consecutive, clinically indicated tilt tests were examined for 207 patients: 176 in SR, 31 in AF. Patients in AF were compared to an age-matched SR cohort (n = 69). Five minute windows immediately before and after tilting were analyzed using time-domain, frequency-domain and nonlinear HRV parameters. Continuous, noninvasive assessment of blood pressure, heart rate and stroke volume were available in the majority of patients. RESULTS There were significant differences at baseline in all HRV parameters between AF and age matched SR. HUT produced significant hemodynamic changes, regardless of cardiac rhythm. Coincident with these hemodynamic changes, patients in AF had a significant increase in median [quartile 1, 2] DFA-α2 (+0.14 [-0.03, 0.32], p < .005) and a decrease in sample entropy (-0.17 [-0.50, -0.01], p < .005). CONCLUSION In the SR cohort, increasing age was associated with fewer HRV changes on tilting. Patients with AF had blunted HRV responses to tilting, mirroring those seen in an age matched SR group. It is feasible to measure HRV in patients with AF and the changes observed on HUT are comparable to those seen in patients in sinus rhythm.
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Affiliation(s)
- Hitesh C Patel
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Carl Hayward
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Lee Middleton
- Department of Cardiology, Ealing Hospital, Southall, United Kingdom
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Carlo Di Mario
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tushar V Salukhe
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Richard Sutton
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Department of Cardiology, Ealing Hospital, Southall, United Kingdom
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