Atrial cellular electrophysiological changes in patients with ventricular dysfunction may predispose to AF

Workman, A.J., Pau, D., Redpath, C., Marshall, G.E., Russell, J.A., Norrie, J., Kane, K.A. and Rankin, A.C. (2009) Atrial cellular electrophysiological changes in patients with ventricular dysfunction may predispose to AF. Heart Rhythm, 6(4), pp. 445-451. (doi: 10.1016/j.hrthm.2008.12.028)

Abstract

<b>Background:</b> Left ventricular systolic dysfunction (LVSD) is a risk factor for atrial fibrillation (AF), but the atrial cellular electrophysiological mechanisms in humans are unclear. Objective This study sought to investigate whether LVSD in patients who are in sinus rhythm (SR) is associated with atrial cellular electrophysiological changes that could predispose to AF. <b>Methods:</b> Right atrial myocytes were obtained from 214 consenting patients in SR who were undergoing cardiac surgery. Action potentials or ion currents were measured using the whole-cell-patch clamp technique. <b>Results:</b> The presence of moderate or severe LVSD was associated with a shortened atrial cellular effective refractory period (ERP) (209 ± 8 ms; 52 cells, 18 patients vs 233 ± 7 ms; 134 cells, 49 patients; P <0.05); confirmed by multiple linear regression analysis. The left ventricular ejection fraction (LVEF) was markedly lower in patients with moderate or severe LVSD (36% ± 4%, n = 15) than in those without LVSD (62% ± 2%, n = 31; P <0.05). In cells from patients with LVEF ≤ 45%, the ERP and action potential duration at 90% repolarization were shorter than in those from patients with LVEF > 45%, by 24% and 18%, respectively. The LVEF and ERP were positively correlated (r = 0.65, P <0.05). The L-type calcium ion current, inward rectifier potassium ion current, and sustained outward ion current were unaffected by LVSD. The transient outward potassium ion current was decreased by 34%, with a positive shift in its activation voltage, and no change in its decay kinetics. <b>Conclusion:</b> LVSD in patients in SR is independently associated with a shortening of the atrial cellular ERP, which may be expected to contribute to a predisposition to AF.

• Item Type: Articles
• Keywords: Human; Left ventricular systolic dysfunction; Ejection fraction; Sinus rhythm; Atrial fibrillation; Electrophysiological remodeling; Isolated myocyte; Effective refractory period; Action potential duration; Ion current
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Rankin, Professor Andrew and Norrie, Prof John and Workman, Dr Antony and Pau, Dr Davide
• Authors: Workman, A.J., Pau, D., Redpath, C., Marshall, G.E., Russell, J.A., Norrie, J., Kane, K.A., and Rankin, A.C.
• Subjects: R Medicine > RC Internal medicine
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; ?? 20206000 ??; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Heart Rhythm
• Publisher: Elsevier
• ISSN: 1547-5271
• Copyright Holders: Copyright © 2009 Elsevier
• First Published: First published in Heart Rhythm 6(4):445-451
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.

Related URLs

• http://dx.doi.org/10.1016/j.hrthm.2009.0...