| The synergism between atrial fibrillation and heart failure. | |
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MedLine Citation:
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PMID: 18474345 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Atrial fibrillation (AF) is a common comorbidity in heart failure (HF) patients and is classically associated with acceleration in the rate of HF progression. The precise mechanism for this interaction is unclear, but comprises "bidirectional" aspects in which AF promotes HF and HF also increases the likelihood of AF. We therefore studied the relationship between AF in an ovine model of pacing-induced congestive HF, in an attempt to identify the mechanisms that underpin the apparent synergistic relationship between AF and HF. METHODS AND RESULTS: Sixteen adult sheep were paced at 190 beats/min for 21 days (HF). AF was induced in 8 of these animals at 14 days' pacing using programmed extrastimuli (HF + AF). Left ventricular hemodynamics and the pattern of cardiac neurohormonal activation, via coronary sinus (CS) sampling, were determined at rest and during submaximal exercise testing in both groups at 21 days and after AF reversion (by atrial defibrillation) at 21 days. CS norepinephrine (NE), endothelin (ET-1), and brain natriuretic peptide (BNP) levels were significantly increased in HF + AF animals, whereas LV end-diastolic pressure (EDP) and LV dP/dt max were significantly reduced compared with moderate HF alone. Cardioversion significantly reduced CS NE and BNP levels and improved contractility in AF + HF animals. In a further 6 animals, we explored the mechanism by which HF increases susceptibility to AF, with specific emphasis on the influence of functional mitral regurgitation. The elimination of MR in HF animals using a percutaneous mitral annular reduction device significantly decreased the inducibility of AF. CONCLUSIONS: AF induction significantly depresses left ventricular function and causes activation of myocardial neurohormones. In conjunction, the presence of functional MR increases susceptibility to AF and this may be attenuated by MR reduction by percutaneous mitral annular reduction. |
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Authors:
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Melissa Byrne; David M Kaye; John Power |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiac failure Volume: 14 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-05-13 Completed Date: 2008-09-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 320-6 Citation Subset: IM |
Affiliation:
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Baker Heart Research Institute, Melbourne, Victoria,Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Atrial Fibrillation / blood, physiopathology* Biological Markers / blood Blood Pressure Comorbidity Disease Progression Electric Countershock Endothelin-1 / blood Heart Failure / blood, physiopathology* Heart Rate Models, Animal Natriuretic Peptide, Brain / blood Norepinephrine / blood Risk Factors Sheep Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Endothelin-1; 114471-18-0/Natriuretic Peptide, Brain; 51-41-2/Norepinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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