Skip Navigation


European Heart Journal Advance Access originally published online on December 20, 2004
European Heart Journal 2005 26(7):705-711; doi:10.1093/eurheartj/ehi066
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
26/7/705    most recent
ehi066v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in EHJ
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (7)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Melenovsky, V.
Right arrow Articles by Kass, D. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Melenovsky, V.
Right arrow Articles by Kass, D. A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2004. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy

Vojtech Melenovsky1, Ilan Hay1, Barry J. Fetics1, Barry A. Borlaug1, Andrew Kramer2, Joseph M. Pastore2, Ronald Berger1 and David A. Kass1,*

1Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
2Guidant Corporation, Minneapolis, MN, USA

Received 29 June 2004; revised 22 September 2004; accepted 28 October 2004; online publish-ahead-of-print 20 December 2004.

* Corresponding author. Tel: +1 410 955 7153; fax: +1 410 955 0852. E-mail address: dkass{at}jhmi.edu

See page 637 for the editorial comment on this article (doi:10.1093/eurheartj/ehi234)

Aims Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function.

Methods and results Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14–30%) were studied using a pressure–volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min–1 mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min–1, ventricular function was similar between the two pacing modes. However, at 120 min–1, irregular pacing impaired systolic (dP/dtmax: –8.2%, P<0.001) and diastolic function (dP/dtmin: +21%, P<0.001, LV end-diastolic pressure: +26%, P=0.007) compared with regular rate pacing. Contractile function during irregular pacing varied with the ratio of preceding/pre-preceding intercycle (RR) interval (dP/dtmax: 80 b.p.m.: r=0.69; 120 b.p.m.: r=0.74), whereas pre-load had little effect on instantaneous contractility.

Conclusion In heart failure subjects with AFib, RR-interval irregularity worsens cardiac function at elevated but not at normal range heart rate. Overall rate control is most important in these patients while rate regularization of rapid AFib may impart additional benefits.

Key Words: Heart failure • Atrial fibrillation • Biventricular pacing • Physiology


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in EHJ:

Heart rate, regularity, and synchronicity in heart failure: a tale of three brothers
Christoph Stellbrink
EHJ 2005 26: 637-638. [Extract] [FREE Full Text]  



This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
J. Bartunek and M. Vanderheyden
Cardiac Dyssynchrony in Congestive Heart Failure and Atrial Fibrillation: Integrating Regularization and Resynchronization
J. Am. Coll. Cardiol., October 7, 2008; 52(15): 1247 - 1249.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
M. Gasparini, A. Auricchio, M. Metra, F. Regoli, C. Fantoni, B. Lamp, A. Curnis, J. Vogt, C. Klersy, and for the Multicentre Longitudinal Observational Stu
Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation
Eur. Heart J., July 1, 2008; 29(13): 1644 - 1652.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
C. Leclercq and P. Mabo
Cardiac resynchronization therapy and atrial fibrillation. Do we have a final answer?
Eur. Heart J., July 1, 2008; 29(13): 1597 - 1599.
[Full Text] [PDF]

Home page
 EuropaceHome page
A. M. Ferreira, P. Adragao, D. M. Cavaco, R. Candeias, F. B. Morgado, K. R. Santos, E. Santos, and J. A. Silva
Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation
Europace, July 1, 2008; 10(7): 809 - 815.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. G. Assomull, S. K. Prasad, J. Lyne, G. Smith, E. D. Burman, M. Khan, M. N. Sheppard, P. A. Poole-Wilson, and D. J. Pennell
Cardiovascular Magnetic Resonance, Fibrosis, and Prognosis in Dilated Cardiomyopathy
J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1977 - 1985.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
P. Ballo, S. Badolati, D. Bernabo, and S. A. Faraguti
Impact of ventricular response irregularity in patients with atrial fibrillation and heart failure
Eur. Heart J., August 2, 2005; 26(16): 1689 - 1690.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
C. Stellbrink
Heart rate, regularity, and synchronicity in heart failure: a tale of three brothers
Eur. Heart J., April 1, 2005; 26(7): 637 - 638.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.