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European Heart Journal Advance Access originally published online on August 22, 2005
European Heart Journal 2005 26(23):2562-2567; doi:10.1093/eurheartj/ehi468
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Atrial fibrillation impairs cardiac sympathetic response to baroreceptor unloading in congestive heart failure

Paul A. Gould1, Michael Yii2, Murray D. Esler3, John M. Power1 and David M. Kaye1,*

1Wynn Department of Metabolic Cardiology, Baker Heart Research Institute, PO Box 6492, St Kilda Road Central, Melbourne VIC 8008, Australia
2Department of Cardiovascular Surgery, St Vincent's Hospital, Melbourne, Australia
3Human Neurotransmitter Laboratory, Baker Heart Research Institute, Melbourne, Australia

Received 9 May 2005; revised 24 July 2005; accepted 28 July 2005; online publish-ahead-of-print 22 August 2005.

* Corresponding author. Tel: +61 3 9276 3265; fax: +61 3 9207 1044. E-mail address: david.kaye{at}baker.edu.au

See page 2490 for the editorial comment on this article (doi:10.1093/eurheartj/ehi598)

Aims In this study, we investigated for a potential mechanism by which atrial fibrillation (AF) might convey a worse prognosis in congestive heart failure (CHF). Specifically, we aimed to determine whether AF impaired cardiac sympathetic response to baroreceptor unloading in comparison to sinus rhythm (SR) in CHF.

Methods and results Eighteen CHF patients (ejection fraction 30±2%, age 59± 2 years), nine in SR and nine in AF, were enrolled. A right heart study and cardiac sympathetic tone assessment by coronary sinus catheter were performed at baseline and after 10 min of 20° and 30° of passive head up tilt (HUT). Filling pressures fell significantly during HUT in both SR and AF groups (AF, P=0.002; SR, P<0.001). The cardiac sympathetic response to HUT was significantly attenuated by AF compared with SR (P=0.014). In conjunction, right atrial appendages were collected from 23 cardiac surgery patients, 12 in SR and 11 in AF to investigate the presence of fibrosis. AF was associated with a significant increase in the collagen density (P=0.025).

Conclusion AF is associated with impaired cardiac sympathetic response to baroreceptor unloading compared with SR in CHF, possibly secondary to atrial fibrosis.

Key Words: Heart failure • Atrial fibrillation • Sympathetic activity • Baroreceptors


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Related articles in EHJ:

Atrial fibrillation and cardiac sympathetic reflexes in heart failure
John S. Floras
EHJ 2005 26: 2490-2492. [Extract] [Full Text]  



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J. S. Floras
Atrial fibrillation and cardiac sympathetic reflexes in heart failure
Eur. Heart J., December 1, 2005; 26(23): 2490 - 2492.
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