Isolated Atrial Microvascular Dysfunction in Patients With Lone Recurrent Atrial Fibrillation

• Published in: Journal of the American College of Cardiology Vol. 51; no. 21; pp. 2053 - 2057
• Main Authors: Skalidis, Emmanuel I., Hamilos, Michalis I., Karalis, Ioannis K., Chlouverakis, Gregory, Kochiadakis, George E., Vardas, Panos E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 27.05.2008; Elsevier Science; Elsevier Limited
• Subjects: Aged; Atrial Fibrillation - physiopathology; Biological and medical sciences; Blood Flow Velocity; Blood Volume; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Case-Control Studies; Catheters; Confidence intervals; Coronary Circulation - physiology; Coronary vessels; Coronary Vessels - diagnostic imaging; Female; Fourier transforms; Heart; Heart attacks; Heart rate; Humans; Internal Medicine; Ischemia; Male; Medical imaging; Medical sciences; Microcirculation; Middle Aged; Mortality; Pathogenesis; Studies; Ultrasonography, Doppler; Ultrasonography, Interventional; LCx; AF; b-APV; APV; LACB; LRAF; h-APV; CFR; left atrial circumflex branch; time-averaged peak coronary flow velocity; lone recurrent atrial fibrillation; time-averaged peak coronary flow velocity after maximal hyperemia; atrial fibrillation; coronary flow reserve; left circumflex coronary artery; time-averaged peak coronary flow velocity at baseline; Human; Microcirculation; Relapse; Arrhythmia; Dysfunction; Heart disease; Atrial fibrillation; Cardiovascular disease; Circulatory system; Recurrent; Cardiology; Excitability disorder
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2008.01.055

Isolated Atrial Microvascular Dysfunction in Patients With Lone Recurrent Atrial Fibrillation Emmanuel I. Skalidis, Michalis I. Hamilos, Ioannis K. Karalis, Gregory Chlouverakis, George E. Kochiadakis, Panos E. Vardas Sixteen patients with lone recurrent atrial fibrillation and 15 control subjects underwent coronary flow velocity measurements in the proximal left circumflex coronary artery and left atrial circumflex branch. Coronary flow reserve of the left atrial circumflex branch in patients with lone recurrent atrial fibrillation was significantly lower than in the control subjects, indicating that microvascular dysfunction is a pathophysiologic substrate associated with this arrhythmia. The purpose of this study was to assess atrial myocardial perfusion in patients with lone recurrent atrial fibrillation (LRAF). Although acute atrial ischemia has been implicated in the pathogenesis of atrial fibrillation, there are few data concerning human atrial myocardial perfusion and none for patients with LRAF. Sixteen patients with LRAF and 15 control subjects with suitable coronary anatomy underwent time-averaged peak coronary blood flow velocity (APV) measurements (cm/s), using a Doppler guidewire in the proximal left circumflex coronary artery (LCx) and in the left atrial circumflex branch (LACB), at baseline (b) and after adenosine administration to achieve maximal hyperemia (h). Coronary flow reserve was defined as h-APV/b-APV. Although there were no statistically significant differences in b-APV between patients with LRAF and control subjects or between the LACB and LCx, there were significant group (p = 0.002), artery (p = 0.001), and interaction (p < 0.001) effects at maximal hyperemia. In patients with LRAF, the h-APV and coronary flow reserve of the LACB (30.4 ± 9.5 cm/s and 2.2 ± 0.4, respectively) were significantly lower than in the LACB of the control subjects (45.8 ± 12.8 cm/s [p < 0.001] and 2.9 ± 0.5 [p = 0.001], respectively) or in the patients' LCx (43.0 ± 10.9 cm/s [p = 0.001] and 3.1 ± 0.6 [p < 0.001], respectively). This study confirms for the first time isolated atrial myocardial perfusion abnormalities in patients with LRAF and coronary flow reserve impairment, indicating that microvascular dysfunction is a pathophysiological substrate associated with this arrhythmia.