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

Paul A Gould1, Michael Yii, Murray D Esler

  • 1Wynn Department of Metabolic Cardiology, Baker Heart Research Institute, PO Box 6492, St Kilda Road Central, Melbourne VIC 8008, Australia.

European Heart Journal
|August 24, 2005
PubMed

Insights

Atrial fibrillation (AF) impairs cardiac sympathetic response in congestive heart failure (CHF) patients with sinus rhythm (SR). This may be due to increased atrial fibrosis in AF patients, worsening their prognosis.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Heart Failure Research

Background:

  • Atrial fibrillation (AF) is linked to a poorer prognosis in patients with congestive heart failure (CHF).
  • The underlying mechanisms connecting AF and adverse outcomes in CHF require further elucidation.
  • Understanding these mechanisms can inform therapeutic strategies.

Purpose of the Study:

  • To investigate if AF impairs the cardiac sympathetic response to baroreceptor unloading in CHF patients.
  • To compare cardiac sympathetic response during baroreceptor unloading between patients with AF and those in sinus rhythm (SR) within a CHF cohort.
  • To explore the potential role of atrial fibrosis in mediating this effect.

Main Methods:

  • Eighteen CHF patients (9 AF, 9 SR) underwent right heart studies and cardiac sympathetic tone assessment via coronary sinus catheterization.
  • Patients were subjected to passive head-up tilt (HUT) to induce baroreceptor unloading.
  • Right atrial appendages from 23 cardiac surgery patients (11 AF, 12 SR) were analyzed for fibrosis.

Main Results:

  • Both SR and AF groups showed significant drops in filling pressures during HUT.
  • Cardiac sympathetic response to HUT was significantly attenuated in the AF group compared to the SR group (P=0.014).
  • AF was associated with a significant increase in atrial collagen density (fibrosis) (P=0.025).

Conclusions:

  • Atrial fibrillation is associated with an impaired cardiac sympathetic response to baroreceptor unloading in patients with congestive heart failure.
  • This impairment may be attributed to increased atrial fibrosis in patients with AF.
  • These findings suggest a potential mechanism for the worse prognosis observed in CHF patients with AF.
Abstract

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