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Karlsson M, Wallman M, Platonov PG, Ulimoen SR, Sandberg F. ECG based assessment of circadian variation in AV-nodal conduction during AF—Influence of rate control drugs. Front Physiol 2022; 13:976526. [PMID: 36267586 PMCID: PMC9577140 DOI: 10.3389/fphys.2022.976526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
The heart rate during atrial fibrillation (AF) is highly dependent on the conduction properties of the atrioventricular (AV) node. These properties can be affected using β-blockers or calcium channel blockers, mainly chosen empirically. Characterization of individual AV-nodal conduction could assist in personalized treatment selection during AF. Individual AV nodal refractory periods and conduction delays were characterized based on 24-hour ambulatory ECGs from 60 patients with permanent AF. This was done by estimating model parameters from a previously created mathematical network model of the AV node using a problem-specific genetic algorithm. Based on the estimated model parameters, the circadian variation and its drug-dependent difference between treatment with two β-blockers and two calcium channel blockers were quantified on a population level by means of cosinor analysis using a linear mixed-effect approach. The mixed-effects analysis indicated increased refractoriness relative to baseline for all drugs. An additional decrease in circadian variation for parameters representing conduction delay was observed for the β-blockers. This indicates that the two drug types have quantifiable differences in their effects on AV-nodal conduction properties. These differences could be important in treatment outcome, and thus quantifying them could assist in treatment selection.
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Affiliation(s)
- Mattias Karlsson
- Department of Systems and Data Analysis, Fraunhofer-Chalmers Centre, Gothenburg, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - 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
| | - Sara R. Ulimoen
- Vestre Viken Hospital Trust, Department of Medical Research, Bærum Hospital, Drammen, Norway
| | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- *Correspondence: Frida Sandberg,
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Computational Simulation of Cardiac Function and Blood Flow in the Circulatory System under Continuous Flow Left Ventricular Assist Device Support during Atrial Fibrillation. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prevalence of atrial fibrillation (AF) is high in heart failure patients supported by a continuous flow left ventricular assist device (CF-LVAD); however, the long term effects remain unclear. In this study, a computational model simulating effects of AF on cardiac function and blood flow for heart failure and CF-LVAD support is presented. The computational model describes left and right heart, systemic and pulmonary circulations and cerebral circulation, and utilises patient-derived RR interval series for normal sinus rhythm (SR). Moreover, AF was simulated using patient-derived unimodal and bimodal distributed RR interval series and patient specific left ventricular systolic functions. The cardiovascular system model simulated clinically-observed haemodynamic outcomes under CF-LVAD support during AF, such as reduced right ventricular ejection fraction and elevated systolic pulmonary arterial pressure. Moreover, relatively high aortic peak pressures and middle arterial peak flow rates during AF with bimodal RR interval distribution, reduced to similar levels as during normal SR and AF with unimodal RR interval distribution under CF-LVAD support. The simulation results suggest that factors such as distribution of RR intervals and systolic left ventricular function may influence haemodynamic outcome of CF-LVAD support during AF.
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Billette J, Tadros R. An integrated overview of AV node physiology. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:805-820. [DOI: 10.1111/pace.13734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/10/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jacques Billette
- Département de Physiologie, Faculté de MédecineUniversité de Montréal Montréal Canada
| | - Rafik Tadros
- Département de Physiologie, Faculté de MédecineUniversité de Montréal Montréal Canada
- Electrophysiology ServiceMontreal Heart Institute Montreal Canada
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Masè M, Disertori M, Marini M, Ravelli F. Characterization of rate and regularity of ventricular response during atrial tachyarrhythmias. Insight on atrial and nodal determinants. Physiol Meas 2017; 38:800-818. [DOI: 10.1088/1361-6579/aa6388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Edvardsson N, Aunes M, Frison L, Berggren AR. Inverse Correlation between the Atrial Fibrillatory Rate and the Ventricular Repolarization Time: Observations at Baseline and after an Intravenous Infusion of a Combined Potassium and Sodium Current Blocker. Ann Noninvasive Electrocardiol 2015; 21:236-45. [PMID: 26246430 DOI: 10.1111/anec.12300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The atrial fibrillatory rate (AFR) and the ventricular rate and repolarization (QTcF) were studied at baseline and under the influence of the combined potassium and sodium current blocker AZD7009. METHODS Ninety-two patients with atrial fibrillation (AF) were randomized to an intravenous infusion of AZD7009 or placebo. The atrial fibrillatory activity in lead V1 was extracted using spatiotemporal QRST cancellation. The exponential decay (ED) characterized the degree of atrial signal organization. RESULTS The mean (SD) AFR at baseline was 396 ± 57 (range 253-584) and 410 ± 33 (range 363-469) bpm in patients randomized to AZD7009 and placebo, respectively. The AFR decreased within the first minutes of the AZD7009 infusion and reached its minimum of 235 ± 34 bpm after 18 minutes. On placebo, the AFR was unchanged. On AZD7009, the ED decreased from 1.2 ± 0.3 to reach its lowest level at 0.7 ± 0.2 after 14 minutes. The ventricular rate did not change significantly over time. The AFR was statistically significantly related to the ventricular repolarization at baseline, the QTcF being longer at lower AFR values, and this relationship remained during and after AZD7009. In the full multivariate linear regression model, including age, sex, left ventricular ejection fraction, QRS duration, heart rate, QTcF, AF episode duration, AF history duration, and right atrial or left atrial size, only QTcF and age were statistically significantly correlated with the AFR. The correlation remained when the uncorrected QT interval was used. CONCLUSIONS The QTcF was inversely correlated with AFR, both at baseline and during administration of AZD7009. The AFR was not correlated with the ventricular rate.
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Affiliation(s)
- Nils Edvardsson
- AstraZeneca R&D, Mölndal, Sweden.,Sahlgrenska Academy at the Sahlgrenska University Hospital, Göteborg, Sweden
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Masè M, Marini M, Disertori M, Ravelli F. Dynamics of AV coupling during human atrial fibrillation: role of atrial rate. Am J Physiol Heart Circ Physiol 2015; 309:H198-205. [DOI: 10.1152/ajpheart.00726.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Abstract
The causal relationship between atrial and ventricular activities during human atrial fibrillation (AF) is poorly understood. This study analyzed the effects of an increase in atrial rate on the link between atrial and ventricular activities during AF. Atrial and ventricular time series were determined in 14 patients during the spontaneous acceleration of the atrial rhythm at AF onset. The dynamic relationship between atrial and ventricular activities was quantified in terms of atrioventricular (AV) coupling by AV synchrogram analysis. The technique identified n: m coupling patterns ( n atrial beats in m ventricular cycles), quantifying their percentage, maximal length, and conduction ratio (= m/ n). Simulations with a difference-equation AV model were performed to correlate the observed dynamics to specific atrial/nodal properties. The atrial rate increase significantly affected AV coupling and ventricular response during AF. The shortening of atrial intervals from 185 ± 32 to 165 ± 24 ms ( P < 0.001) determined transitions toward AV patterns with progressively decreasing m/ n ratios (from conduction ratio = 0.34 ± 0.09 to 0.29 ± 0.08, P < 0.01), lower occurrence (from percentage of coupled beats = 27.1 ± 8.0 to 21.8 ± 6.9%, P < 0.05), and higher instability (from maximal length = 3.9 ± 1.5 to 2.8 ± 0.7 s, P < 0.01). Advanced levels of AV block and coupling instability at higher atrial rates were associated with increased ventricular interval variability (from 123 ± 52 to 133 ± 55 ms, P < 0.05). AV pattern transitions and coupling instability in patients were predicted, assuming the filtering of high-rate irregular atrial beats by the slow recovery of nodal excitability. These results support the role of atrial rate in determining AV coupling and ventricular response and may have implications for rate control in AF.
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Affiliation(s)
- M. Masè
- Department of Physics, University of Trento, Povo-Trento, Italy
| | - M. Marini
- Division of Cardiology, Santa Chiara Hospital, Trento, Italy; and
| | - M. Disertori
- Division of Cardiology, Santa Chiara Hospital, Trento, Italy; and
- Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy
| | - F. Ravelli
- Department of Physics, University of Trento, Povo-Trento, Italy
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Jaakkola J, Hartikainen JEK, Kiviniemi T, Nuotio I, Nammas W, Grönberg T, Karmi A, Ylitalo A, Airaksinen KEJ. Ventricular rate during acute atrial fibrillation and outcome of electrical cardioversion: The FinCV Study. Ann Med 2015; 47:341-5. [PMID: 25943162 DOI: 10.3109/07853890.2015.1031821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The impact of ventricular rate (VR) on the outcome of electrical cardioversion (ECV) of acute atrial fibrillation (AF) is currently unknown. We aimed to determine the effect of VR during acute AF on the success of ECV, recurrence of AF, and occurrence of post-cardioversion complications in 30 days of follow-up. METHODS A total of 6,624 ECVs were performed in 2,821 consecutive patients with AF lasting < 48 hours. VR ≤ 60 bpm was defined low, and VR ≥ 160 bpm high. RESULTS The median VR before ECV was 109 bpm. The success rate of ECV was 94.2%. Bradycardia occurred in 62 (0.9%) and thromboembolic complications in 39 (0.6%) ECVs. Low VR was observed before 75 (1.1%) ECVs, and male sex was its only independent predictor. High VR was observed in 165 (2.5%) ECVs. The independent predictors of high VR were younger age, < 12 h episode duration, no previous history of AF, and alcohol abuse. Low or high VR were not related to the success of ECV, incidence of thromboembolic or bradycardic complications, or recurrence of AF, although VR was significantly (P < 0.001) lower in the patients in whom AF recurred. CONCLUSION VR during acute AF does not affect the efficacy or safety of ECV.
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Affiliation(s)
- Jussi Jaakkola
- Heart Center, Turku University Hospital and University of Turku , Finland
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Corino VDA, Sandberg F, Mainardi LT, Platonov PG, Sörnmo L. Noninvasive Assessment of Atrioventricular Nodal Function: Effect of Rate-Control Drugs during Atrial Fibrillation. Ann Noninvasive Electrocardiol 2014; 20:534-41. [PMID: 25545540 DOI: 10.1111/anec.12253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND During atrial fibrillation (AF), conventional electrophysiological techniques for assessment of refractory period or conduction velocity of the atrioventricular (AV) node cannot be used. We aimed at evaluating changes in AV nodal properties during administration of tecadenoson and esmolol using a novel ECG-based method. METHODS Fourteen patients (age 58 ± 8 years, 10 men) with AF were randomly assigned to either 75 or 300 μg intravenous tecadenoson. After tecadenoson wash-out, patients received esmolol continuously (100 μg/kg per min for 10 mins, then 50 μg/kg per min for 50 mins). Atrial fibrillatory rate (AFR) and heart rate (HR) were assessed in 15-min segments. Using the novel method, we assessed the absolute refractory periods of the slow and fast pathways (aRPs and aRPf) of the AV node to produce an estimate of the functional refractory period. RESULTS During esmolol infusion, AFR and HR were significantly decreased and the absolute refractory period was significantly prolonged in both pathways (aRPs: 387 ± 73 vs 409 ± 62 ms, P < 0.05; aRPf: 490 ± 80 vs 529 ± 58 ms, P < 0.05). During both tecadenoson doses, HR decreased significantly and AFR was unchanged. Both aRPs and aRPf were prolonged for a 75 μg dose (aRPs: 322 ± 97 vs 476 ± 75 ms, P < 0.05; aRPf: 456 ± 102 vs 512 ± 55 ms, P < 0.05) whereas a trend toward prolongation was observed for a 300 μg dose. CONCLUSIONS The estimated parameters reflect expected changes in AV nodal properties, i.e., slower conduction through the AV node for tecadenoson and prolongation of the AV node refractory period for esmolol. Thus, the proposed approach may be used to assess drug effects on the AV node in AF patients.
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Affiliation(s)
- Valentina D A Corino
- Department of Electronics, Information and Bioengineering, Politecnico of Milano, Italy
| | - Frida Sandberg
- Department of Biomedical Engineering and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden
| | - Luca T Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico of Milano, Italy
| | - Pyotr G Platonov
- Center for Integrative Electrocardiology at Lund University (CIEL) and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
| | - Leif Sörnmo
- Department of Biomedical Engineering and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden
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Chudzik M, Cygankiewicz I, Klimczak A, Lewek J, Bartczak K, Wranicz JK. Short-term ECG recordings for heart rate assessment in patients with chronic atrial fibrillation. Arch Med Sci 2014; 10:676-83. [PMID: 25276150 PMCID: PMC4175769 DOI: 10.5114/aoms.2014.44859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 04/11/2011] [Accepted: 03/11/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is no consensus on the length of ECG tracing that should be recorded to represent adequate rate control in patients with atrial fibrillation (AFib). The purpose of the study was to examine whether heart rate measurements based on short-term ECGs recorded at different periods of the day may correspond to the mean heart rate and rate irregularity analyzed from standard 24-hour Holter monitoring. MATERIAL AND METHODS The study enrolled 50 consecutive patients with chronic AFib who underwent 24-hour Holter monitoring. Mean heart rate (mHR) and the coefficient of irregularity (CI) were assessed from 5- and 60-minute intervals of Holter recordings in different periods of the day. RESULTS The highest correlation in mean heart rate interval within 24 h was found during a 6-hour sample and in the periods 11.00 AM-12.00 PM, 12 PM-1.00 PM, and 1.00 PM-2.00 PM. With respect to irregularity, only the CI measurements based on a 6-hour interval (7.00 AM-1.00 AM) show a correlation > 0.08 compared to data from the 24-hour recording. CONCLUSIONS Only long-term (6-hour) recordings provide a high correlation within 24 h in mean heart rate interval and coefficient of irregularity. It seems that the mean heart rate interval in 1-hour periods between 11 AM and 2 PM might be predictive for 24-hour data. Short time recordings of the coefficient of irregularity of heart rate in AFib patients at this moment are not useful in clinical practice for long-term prognosis of ventricular irregularity.
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Affiliation(s)
- Michal Chudzik
- Department of Electrocardiology, Medical University of Lodz, Poland
| | | | - Artur Klimczak
- Department of Electrocardiology, Medical University of Lodz, Poland
| | - Joanna Lewek
- Department of Electrocardiology, Medical University of Lodz, Poland
| | - Karol Bartczak
- Department of Cardiosurgery, Medical University of Lodz, Poland
| | - Jerzy K. Wranicz
- Department of Electrocardiology, Medical University of Lodz, Poland
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Nonlinear synchronization assessment between atrial and ventricular activations series from the surface ECG in atrial fibrillation. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Masè M, Glass L, Disertori M, Ravelli F. The AV synchrogram: A novel approach to quantify atrioventricular coupling during atrial arrhythmias. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masè M, Glass L, Disertori M, Ravelli F. Nodal recovery, dual pathway physiology, and concealed conduction determine complex AV dynamics in human atrial tachyarrhythmias. Am J Physiol Heart Circ Physiol 2012; 303:H1219-28. [DOI: 10.1152/ajpheart.00228.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The genesis of complex ventricular rhythms during atrial tachyarrhythmias in humans is not fully understood. To clarify the dynamics of atrioventricular (AV) conduction in response to a regular high-rate atrial activation, 29 episodes of spontaneous or pacing-induced atrial flutter (AFL), covering a wide range of atrial rates (cycle lengths from 145 to 270 ms), were analyzed in 10 patients. AV patterns were identified by applying firing sequence and surrogate data analysis to atrial and ventricular activation series, whereas modular simulation with a difference-equation AV node model was used to correlate the patterns with specific nodal properties. AV node response at high atrial rate was characterized by 1) AV patterns of decreasing conduction ratios at the shortening of atrial cycle length (from 236.3 ± 32.4 to 172.6 ± 17.8 ms) according to a Farey sequence ordering (conduction ratio from 0.34 ± 0.12 to 0.23 ± 0.06; P < 0.01); 2) the appearance of high-order alternating Wenckebach rhythms, such as 6:2, 10:2, and 12:2, associated with ventricular interval oscillations of large amplitude (407.7 ± 150.4 ms); and 3) the deterioration of pattern stability at advanced levels of block, with the percentage of stable patterns decreasing from 64.3 ± 35.2% to 28.3 ± 34.5% ( P < 0.01). Simulations suggested these patterns to originate from the combined effect of nodal recovery, dual pathway physiology, and concealed conduction. These results indicate that intrinsic nodal properties may account for the wide spectrum of AV block patterns occurring during regular atrial tachyarrhythmias. The characterization of AV nodal function during different AFL forms constitutes an intermediate step toward the understanding of complex ventricular rhythms during atrial fibrillation.
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Affiliation(s)
- Michela Masè
- Department of Physics and BioTech, University of Trento, Povo-Trento, Italy
| | - Leon Glass
- Department of Physiology, McGill University, Montreal, Québec, Canada; and
| | | | - Flavia Ravelli
- Department of Physics and BioTech, University of Trento, Povo-Trento, Italy
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An Atrioventricular Node Model for Analysis of the Ventricular Response During Atrial Fibrillation. IEEE Trans Biomed Eng 2011; 58:3386-95. [DOI: 10.1109/tbme.2011.2166262] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Climent AM, Atienza F, Millet J, Guillem MS. Generation of realistic atrial to atrial interval series during atrial fibrillation. Med Biol Eng Comput 2011; 49:1261-8. [DOI: 10.1007/s11517-011-0823-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 07/31/2011] [Indexed: 11/28/2022]
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