Circulation Research, Vol 51, 205-215, Copyright © 1982 by American Heart Association

ARTICLES

The effects of atrial fibrillation on atrial pressure-volume and flow relationships

CW White, RE Kerber, HR Weiss and ML Marcus

To study whether atrial fibrillation might produce local changes in the atrium which could facilitate the tendency of this arrhythmia to become chronic and self-perpetuating, we compared the effect of atrial fibrillation, atrial pacing, and acute volume loading on the perfusion and oxygen consumption of the atrium in anesthetized dogs. Measurement of atrial perfusion with microspheres indicates that during atrial fibrillation, atrial blood flow increases 2- to 3-fold. Right atrial pacing is a significantly less potent metabolic stimulus for atrial vasodilation. Using Doppler velocity recordings of sinus node artery blood flow velocity, a marked increase in velocity is observed within 5 seconds after the initiation of atrial fibrillation. During atrial fibrillation, the sinus node artery reactive hyperemia response is markedly attenuated. Atrial fibrillation acutely decreases atrial distensibility; atrial pressure increased 81 +/- 19% with only a small increase (9.7 +/- 3%) in atrial diameter measured by echocardiography. During sinus rhythm, volume expansion to equivalent levels of atrial pressure as seen during atrial fibrillation increased atrial diameter 21 +/- 5% P less than 0.05. Atrial oxygen consumption determined by the microspectrophotometric method markedly increases during atrial fibrillation, compared to control conditions (12.3 +/- 2.8 vs. 3.9 +/- 0.6 ml O2/min per 100 g, respectively) P less than 0.05. Atrial O2 extraction was 5.5 +/- 0.4 ml O2/ml blood in the control state, and did not change with interventions. There was a linear relationship between left atrial O2 consumption and blood flow in all experimental conditions. Atrial fibrillation therefore alters atrial hemodynamics and metabolism by increasing atrial blood flow and oxygen consumption and decreasing atrial distensibility. Since atrial perfusion during atrial fibrillation is high and atrial flow reserve is limited, it is possible that additional atrial metabolic requirements might lead to atrial ischemia, fibrosis, and, thereby, perpetuation of the arrhythmia.

This article has been cited by other articles:

				J. L. Serra and M. Bendersky Review: Atrial fibrillation and renin-angiotensin system Therapeutic Advances in Cardiovascular Disease, June 1, 2008; 2(3): 215 - 223. [Abstract] [PDF]

				E. I. Skalidis, M. I. Hamilos, I. K. Karalis, G. Chlouverakis, G. E. Kochiadakis, and P. E. Vardas Isolated Atrial Microvascular Dysfunction in Patients With Lone Recurrent Atrial Fibrillation J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2053 - 2057. [Abstract] [Full Text] [PDF]

				M. Mayr, S. Yusuf, G. Weir, Y.-L. Chung, U. Mayr, X. Yin, C. Ladroue, B. Madhu, N. Roberts, A. De Souza, et al. Combined metabolomic and proteomic analysis of human atrial fibrillation. J. Am. Coll. Cardiol., February 5, 2008; 51(5): 585 - 594. [Abstract] [Full Text] [PDF]

				Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]

				A. S. Barth, S. Merk, E. Arnoldi, L. Zwermann, P. Kloos, M. Gebauer, K. Steinmeyer, M. Bleich, S. Kaab, M. Hinterseer, et al. Reprogramming of the Human Atrial Transcriptome in Permanent Atrial Fibrillation: Expression of a Ventricular-Like Genomic Signature Circ. Res., May 13, 2005; 96(9): 1022 - 1029. [Abstract] [Full Text] [PDF]

				U. Schotten, S. de Haan, H.-R. Neuberger, S. Eijsbouts, Y. Blaauw, R. Tieleman, and M. Allessie Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H2324 - H2331. [Abstract] [Full Text] [PDF]

				S. Wasson, H. K. Reddy, and M. L. Dohrmann Current Perspectives of Electrical Remodeling and Its Therapeutic Implications Journal of Cardiovascular Pharmacology and Therapeutics, April 1, 2004; 9(2): 129 - 144. [Abstract] [PDF]

				E. I. Skalidis, G. E. Kochiadakis, N. E. Igoumenidis, K. E. Vardakis, and P. E. Vardas Phasic coronary blood flow velocity pattern and flow reserve in the atrium: regulation of left atrial myocardial perfusion J. Am. Coll. Cardiol., February 19, 2003; 41(4): 674 - 680. [Abstract] [Full Text] [PDF]

				M. P. van den Berg, G. Tjeerdsma, P. J. de Kam, F. Boomsma, H. J.G.M. Crijns, and D. J. van Veldhuisen Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure Eur J Heart Fail, June 1, 2002; 4(3): 255 - 262. [Abstract] [Full Text] [PDF]

				M. Allessie, J. Ausma, and U. Schotten Electrical, contractile and structural remodeling during atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 230 - 246. [Abstract] [Full Text] [PDF]

				Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]

				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]

				N.M. Al-Saady and M. Sopher Prothrombotic markers in atrial fibrillation: what is new? Eur. Heart J., September 2, 2001; 22(18): 1635 - 1639. [PDF]

				M. J. Mihm, F. Yu, C. A. Carnes, P. J. Reiser, P. M. McCarthy, D. R. Van Wagoner, and J. A. Bauer Impaired Myofibrillar Energetics and Oxidative Injury During Human Atrial Fibrillation Circulation, July 10, 2001; 104(2): 174 - 180. [Abstract] [Full Text] [PDF]

				A. Goette, T. Staack, C. Rocken, M. Arndt, J. C. Geller, C. Huth, S. Ansorge, H. U. Klein, and U. Lendeckel Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1669 - 1677. [Abstract] [Full Text] [PDF]

				M.P. Ingemansson, B. Smideberg, and S.B. Olsson Intravenous MgSO4alone and in combination with glucose, insulin and potassium (GIK) prolong the atrial cycle length in chronic atrial fibrillation Europace, January 1, 2000; 2(2): 106 - 114. [Abstract] [PDF]

				C. Stefanadis, J. Dernellis, C. Stratos, E. Tsiamis, C. Vlachopoulos, K. Toutouzas, S. Lambrou, C. Pitsavos, and P. Toutouzas Effects of balloon mitral valvuloplasty on left atrial function in mitral stenosis as assessed by pressure-area relation J. Am. Coll. Cardiol., July 1, 1998; 32(1): 159 - 168. [Abstract] [Full Text] [PDF]

				M. C. E. F. Wijffels, C. J. H. J. Kirchhof, R. Dorland, J. Power, and M. A. Allessie Electrical Remodeling due to Atrial Fibrillation in Chronically Instrumented Conscious Goats : Roles of Neurohumoral Changes, Ischemia, Atrial Stretch, and High Rate of Electrical Activation Circulation, November 18, 1997; 96(10): 3710 - 3720. [Abstract] [Full Text]

				J. Ausma, M. Wijffels, F. Thone, L. Wouters, M. Allessie, and M. Borgers Structural Changes of Atrial Myocardium due to Sustained Atrial Fibrillation in the Goat Circulation, November 4, 1997; 96(9): 3157 - 3163. [Abstract] [Full Text]

				R. G. Tieleman, C. D. J. De Langen, I. C. Van Gelder, P. J. de Kam, J. Grandjean, K. J. Bel, M. C. E. F. Wijffels, M. A. Allessie, and H. J. G. M. Crijns Verapamil Reduces Tachycardia-Induced Electrical Remodeling of the Atria Circulation, April 1, 1997; 95(7): 1945 - 1953. [Abstract] [Full Text]

				E. Leistad, G. Aksnes, E. Verburg, and G. Christensen Atrial Contractile Dysfunction After Short-term Atrial Fibrillation Is Reduced by Verapamil but Increased by BAY K8644 Circulation, May 1, 1996; 93(9): 1747 - 1754. [Abstract] [Full Text]

				M. C.E.F. Wijffels, C. J.H.J. Kirchhof, R. Dorland, and M. A. Allessie Atrial Fibrillation Begets Atrial Fibrillation : A Study in Awake Chronically Instrumented Goats Circulation, October 1, 1995; 92(7): 1954 - 1968. [Abstract] [Full Text]

				M. Arndt, U. Lendeckel, C. Rocken, K. Nepple, C. Wolke, A. Spiess, C. Huth, S. Ansorge, H. U. Klein, and A. Goette Altered Expression of ADAMs (A Disintegrin And Metalloproteinase) in Fibrillating Human Atria Circulation, February 12, 2002; 105(6): 720 - 725. [Abstract] [Full Text] [PDF]