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Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes

M Guazzi1, S Belletti, L Lenatti

  • 1University of Milan, San Paolo Hospital, Milan, Italy. marco.guazzi@unimi.it

European Journal of Clinical Investigation
|December 22, 2006
PubMed

Insights

Cardioversion improves endothelial function in atrial fibrillation (AF) patients, especially those with hypertension. However, this benefit is not observed in patients with diabetes, indicating comorbidities impact treatment outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Endothelial Function Research
  • Atrial Fibrillation Therapeutics

Background:

  • Atrial fibrillation (AF) is linked to endothelial dysfunction, a condition also prevalent in hypertension and diabetes.
  • The study investigates if these comorbidities exacerbate endothelial dysfunction in AF and if cardioversion (CV) offers benefits.

Purpose of the Study:

  • To assess the impact of cardioversion (CV) on endothelial function in patients with lone atrial fibrillation (AF), AF with hypertension, and AF with type II diabetes.
  • To determine if comorbidities like hypertension and diabetes have an additive effect on endothelial dysfunction in AF patients.

Main Methods:

  • Brachial artery flow-mediated dilatation (FMD) was measured before and after CV in three groups: lone AF, AF + hypertension, and AF + diabetes.
  • Measurements were taken in both supine and head-up tilting (HUT) positions to evaluate endothelial vasodilation responses.

Main Results:

  • Cardioversion significantly improved FMD in lone AF patients and those with AF and hypertension.
  • No significant improvement in FMD was observed in patients with AF and diabetes, regardless of cardiac rhythm.
  • Sustained improvements in FMD post-CV were noted in groups 1 and 2 with continued sinus rhythm, but not with AF relapse.

Conclusions:

  • Cardioversion enhances endothelial responsiveness in AF patients with or without hypertension but not in those with diabetes.
  • Pre-existing endothelial impairment in diabetes may explain the lack of response to cardioversion, unlike in hypertension.
  • Comorbidities significantly influence the effectiveness of cardioversion in restoring endothelial function in AF patients.
Abstract

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