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Predictive value of atrial high‐rate episodes for arterial stiffness and endothelial dysfunction in dual‐chamber pacemaker patients
Author(s) -
Krishnamoorthy Suresh,
Khoo Chee W.,
Lim Hoong S.,
Lip Gregory Y. H.
Publication year - 2014
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12182
Subject(s) - cardiology , medicine , arterial stiffness , endothelial dysfunction , endothelium , acetylcholine , anesthesia , blood pressure
Background Various pacing studies have demonstrated an association between right ventricular pacing ( RV p) and atrial fibrillation ( AF ), even after preserving atrioventricular ( AV ) synchrony. We aimed to assess the interaction between arterial stiffness, endothelial function and atrial high‐rate episodes ( AHRE ) in patients with dual‐chamber pacemakers. Methods We studied 101 patients with dual‐chamber pacemakers incorporated with sophisticated AF detection and therapy algorithms. Macrovascular endothelial dysfunction ( ED ) was measured by the relative change in aortic augmentation index ( AI x), using carotid artery applanation tonometry in response to inhaled salbutamol and sublingual glyceryl trinitrate. Microvascular ED was measured by cutaneous laser Doppler flowmetry ( LDF ) in response to acetylcholine (Ach, endothelium dependent) and sodium nitroprusside ( SNP , endothelium independent). Arterial stiffness was measured using carotid‐femoral pulse wave velocity ( PWV cf ). ‘Reservoir pressure’ (Pr, MATLAB ) describes the aortic ‘cushioning’ properties. Results Mean age of the cohort was 72·1 ± 10·8 years; men ( n = 69) 68·3%. Of 101 dual‐chamber pacemaker patients, 23·8% ( n = 24) had AHRE detected on the baseline pacemaker interrogation. PP , PWV cf and Pr were significantly higher in patients with AHRE compared with those without AHRE . The change in AI x with salbutamol (∆% AI x Sal) and acetylcholine‐induced changes in LDF (Δ% LDF Ach) were lower in patients with AHRE compared with those without AHRE . In patients with AHRE , significant correlations were observed between%Vp and Δ% LDF Ach ( P = 0·03) as well as between PP and Δ% LDF Ach ( P = 0·05). On multivariate analysis, PP , Pr, PWV cf and ∆% AI x Sal remained as independent predictors of AHRE . Conclusion In patients with dual‐chamber pacemakers, both higher arterial stiffness and greater endothelial dysfunction independently predicted AHRE , irrespective of the degree (or mode) of pacing. Arterial stiffness and endothelial dysfunction may potentially contribute to the perpetuation of atrial arrhythmias beyond the adverse effects of ventricular pacing alone.