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High beat-to-beat blood pressure variability in atrial fibrillation compared to sinus rhythm
Joakim Olbers1, Adam Gille1, Petter Ljungman2
1a Unit of Cardiology, Department of Clinical Science and Education , Södersjukhuset, Karolinska Institutet , Stockholm , Sweden.
Insights
Patients with atrial fibrillation (AF) exhibit significantly higher beat-to-beat blood pressure variability than those in sinus rhythm. This increased variability may contribute to cardiovascular risks associated with AF.
Area of Science:
- Cardiology
- Hemodynamics
- Clinical Research
Background:
- Atrial fibrillation (AF) increases cardiovascular morbidity and mortality, with mechanisms beyond thromboembolism being unclear.
- High blood pressure (BP) is a known cardiovascular risk factor, but its interaction with AF requires further investigation.
Purpose of the Study:
- To quantify and compare beat-to-beat blood pressure variability in patients with AF versus those in sinus rhythm.
- To investigate the relationship between AF and BP variability.
Main Methods:
- Invasive BP was recorded in 33 patients (21 AF, 12 sinus rhythm) during coronary angiography.
- Beat-to-beat BP variability was calculated for systolic and diastolic pressures at radial, brachial, and aortic sites.
Main Results:
- Systolic BP variability was approximately double in the AF group (4.9 mmHg) compared to sinus rhythm (2.4 mmHg).
- Diastolic BP variability was about six times higher in the AF group (7.5 mmHg) versus sinus rhythm (1.2 mmHg).
- Significant differences in BP variability were observed across all measurement locations (p < .001).
Conclusions:
- Patients with AF demonstrate substantially elevated beat-to-beat BP variability compared to sinus rhythm patients.
- This heightened hemodynamic variability may adversely impact vascular health, potentially explaining increased cardiovascular risks in AF.
Purpose:
Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, not entirely explained by thromboembolism. The underlying mechanisms for this association are largely unknown. Similarly, high blood pressure (BP) increases the risk for cardiovascular events. Despite this the interplay between AF and BP is insufficiently studied. The purpose of this study was to examine and quantify the beat-to-beat blood pressure variability in patients with AF in comparison to a control group of patients with sinus rhythm.
Materials And Methods:
We studied 33 patients - 21 in atrial fibrillation and 12 in sinus rhythm - undergoing routine coronary angiography. Invasive blood pressure was recorded at three locations: radial artery, brachial artery and ascending aorta. Blood pressure variability, defined as average beat-to-beat blood pressure difference, was calculated for systolic and diastolic blood pressure at each site.
Results:
We observed a significant difference (p < .001) in systolic and diastolic blood pressure variability between the atrial fibrillation and sinus rhythm groups at all locations. Systolic blood pressure variability roughly doubled in the atrial fibrillation group compared to the sinus rhythm group (4.9 and 2.4 mmHg respectively). Diastolic beat-to-beat blood pressure variability was approximately 6 times as high in the atrial fibrillation group compared to the sinus rhythm group (7.5 and 1.2 mmHg respectively). No significant difference in blood pressure variability was seen between measurement locations.
Conclusions:
Beat-to-beat blood pressure variability in patients with atrial fibrillation was substantially higher than in patients with sinus rhythm. Hemodynamic effects of this beat-to-beat variation in blood pressure may negatively affect vascular structure and function, which may contribute to the increased cardiovascular morbidity and mortality seen in patients with atrial fibrillation.
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