Non-invasive evaluation of the effect of metoprolol on the atrioventricular node during permanent atrial fibrillation

被引:5
作者
Corino, Valentina D. A. [1 ]
Sandberg, Frida [2 ,3 ]
Platonov, Pyotr G. [4 ,5 ]
Mainardi, Luca T. [1 ]
Ulimoen, Sara R. [6 ]
Enger, Steve [6 ]
Tveit, Arnljot [6 ]
Sornmo, Leif [2 ,3 ]
机构
[1] Politecn Milan, Dipartimento Elettron Informaz & Bioingn, Via Golgi 39, I-20133 Milan, Italy
[2] Lund Univ, Dept Biomed Engn, SE-22100 Lund, Sweden
[3] Lund Univ, CIEL, Ctr Integrat Electrocardiol, SE-22100 Lund, Sweden
[4] Lund Univ, CIEL, Ctr Integrat Electrocardiol, SE-22185 Lund, Sweden
[5] Skane Univ Hosp, Arrhythmia Clin, SE-22185 Lund, Sweden
[6] Vestre Viken Hosp Trust, Baerum Hosp, Dept Med Res, N-3004 Drammen, Norway
来源
EUROPACE | 2014年 / 16卷
基金
瑞典研究理事会;
关键词
Atrial fibrillation; Atrioventricular node; Refractory period; Metoprolol; Ventricular rate; Rate control; Functional refractory period; Beta-blocker; SURFACE ELECTROCARDIOGRAM; FREQUENCY-ANALYSIS; VENTRICULAR RATE; CONDUCTION PROPERTIES; ANTIARRHYTHMIC-DRUGS; BETA-BLOCKADE; RHYTHM; REFRACTORINESS; VARIABILITY; MODULATION;
D O I
10.1093/europace/euu246
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims During atrial fibrillation (AF), conventional electrophysiological techniques for assessment of refractory period or conduction velocity of the atrioventricular (AV) node cannot be used. We aimed at evaluating changes inAVnodal properties during administration of metoprolol from electrocardiogram data, and to support our findings with simulated data based on results from an electrophysiological study. Methods and results Sixty patients (age 71 +/- 9 years, 42 men) with permanent AF were included in the RATe control in Atrial Fibrillation (RATAF) study. Two 15 min segments, during baseline and metoprolol administration, starting at 2 pm were analysed in this study. Atrial fibrillatory rate (AFR), heart rate (HR), and AV nodal parameters were assessed. The AV nodal parameters account for the probability of an impulse not taking the fast pathway, the absolute refractory periods of the slow and fast pathways (aRPs and aRPf), representing the functional refractory period, and their respective prolongation in refractory period. In addition, simulated RR series were generated that mimic metoprolol administration through prolonged AV conduction interval and AV node effective refractory period. During metoprolol administration, AFR and HR were significantly decreased and aRP was significantly prolonged in both pathways (aRPs: 337 +/- 60 vs. 398 +/- 79 ms, P < 0.01; aRPf: 430 +/- 91 vs. 517 +/- 100 ms, P < 0.01). Similar results were found for the simulated RR series, both aRPs and aRPf being prolonged with metoprolol (aRPs: 413 +/- 33 vs. 437 +/- 43 ms, P = 0.01; aRPf: 465 +/- 40 vs. 502 +/- 69 ms, P = 0.02). Conclusion The AV nodal parameters reflect expected changes after metoprolol administration, i. e. a prolongation in functional refractory period. The simulations confirmed that aRPs and aRPf may serve as an estimate of the functional refractory period.
引用
收藏
页码:129 / 134
页数:6
相关论文
共 38 条
[1]   RELATION BETWEEN MINIMUM RR INTERVAL DURING ATRIAL-FIBRILLATION AND FUNCTIONAL REFRACTORY PERIOD OF AV-JUNCTION [J].
BILLETTE, J ;
NADEAU, RA ;
ROBERGE, F .
CARDIOVASCULAR RESEARCH, 1974, 8 (03) :347-351
[2]   Frequency analysis of human atrial fibrillation using the surface electrocardiogram and its response to ibutilide [J].
Bollmann, A ;
Kanuru, NK ;
McTeague, KK ;
Walter, PF ;
DeLurgio, DB ;
Langberg, JJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 81 (12) :1439-1445
[3]   Importance of left atrial diameter and atrial fibrillatory frequency for conversion of persistent atrial fibrillation with oral flecainide [J].
Bollmann, A ;
Binias, KH ;
Toepffer, I ;
Molling, J ;
Geller, C ;
Klein, HU .
AMERICAN JOURNAL OF CARDIOLOGY, 2002, 90 (09) :1011-+
[4]  
Camm AJ, 2012, EUROPACE, V14, P1385, DOI [10.1093/eurheartj/ehs253, 10.1093/europace/eus305]
[5]   THE ACUTE ELECTRO-PHYSIOLOGICAL EFFECTS OF INTRAVENOUS METOPROLOL [J].
CAMM, AJ ;
WARD, DE ;
WHITMARSH, VB .
CLINICAL CARDIOLOGY, 1982, 5 (05) :327-331
[6]   Low atrial fibrillatory rate is associated with spontaneous conversion of recent-onset atrial fibrillation [J].
Choudhary, Mariam B. ;
Holmqvist, Fredrik ;
Carlson, Jonas ;
Nilsson, Hans-Jorgen ;
Roijer, Anders ;
Platonov, Pyotr G. .
EUROPACE, 2013, 15 (10) :1445-1452
[7]  
Climent AM, 2010, PACING CLIN ELECTROP, V33, P1
[8]  
Corino VDA, 2007, IFMBE PROC, V16, P82
[9]   Beta-blockade and A1-adenosine receptor agonist effects on atrial fibrillatory rate and atrioventricular conduction in patients with atrial fibrillation [J].
Corino, Valentina D. A. ;
Holmqvist, Fredrik ;
Mainardi, Luca T. ;
Platonov, Pyotr G. .
EUROPACE, 2014, 16 (04) :587-594
[10]   Atrioventricular nodal function during atrial fibrillation: Model building and robust estimation [J].
Corino, Valentina D. A. ;
Sandberg, Frida ;
Lombardi, Federico ;
Mainardi, Luca T. ;
Sornmo, Leif .
BIOMEDICAL SIGNAL PROCESSING AND CONTROL, 2013, 8 (06) :1017-1025