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European Heart Journal Advance Access published online on August 22, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi468
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received May 9, 2005
Revised July 24, 2005
Accepted July 28, 2005

Clinical research

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

Paul A. Gould 1, Michael Yii 2, Murray D. Esler 3, John M. Power 1, and David M. Kaye 1*

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

* To whom correspondence should be addressed.
David M. Kaye, E-mail: david.kaye{at}baker.edu.au


  Abstract

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.

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