The Restitution Threshold Index Characterizes the Association Between Atrial Fibrillation Ventricular Rate and Ejection Fraction

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-02-01 DOI:10.1016/j.jacep.2024.10.020

Nikhil Ahluwalia MBBS, MSc, Shohreh Honarbakhsh MBBS, PhD, Abhishek Joshi MB, ChB, PhD, Hakam Abbass, Anthony W. Chow MBBS, MD, Mehul Dhinoja MBBS, Steffen E. Petersen MD, DPhil, Guy Lloyd MD, Ross J. Hunter MBBS, PhD, Richard J. Schilling MBBS, MD

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引用次数: 0

Abstract

Background

Patients with reduced left ventricular ejection fraction (LVEF) and rate-controlled atrial fibrillation (AF) may improve after restoring sinus rhythm. This may be due to the elimination of the short R-R intervals during AF even when mean heart rate is acceptable.

Objectives

This work aims to evaluate a novel parameter representing the burden of short R-R intervals during AF and its association with reduced LVEF and LVEF recovery after catheter ablation (CA).

Methods

Patients with persistent AF were prospectively enrolled pre-CA and grouped as having reduced (LVEF ≤50%) or preserved LVEF. Sequential R-R intervals on resting Holter monitoring were measured. We sought to define a threshold R-R interval at which the difference in the percentage of short R-R intervals is greatest when comparing patients with reduced and preserved ejection fraction. We termed this threshold the restitution threshold (RT) in the belief that this may be possible to apply as a threshold to identify patients with AF-mediated cardiomyopathy. This percentage burden of intervals shorter than the RT was defined as the restitution threshold index (RTI). The association with reduced LVEF in AF and predicting improvement in LVEF after CA was then evaluated.

Results

A total of 104 patients were enrolled; 53 (51%) had a reduced LVEF. There was no difference in mean heart rate; however, at an RT of 660 ms, the RTI was higher in the reduced LVEF arm (56.1% ± 23.1% vs 39.5% ± 26.0%; P < 0.001). It was an independent predictor of left ventricular systolic dysfunction. The RTI in the reduced LVEF arm had an area under the receiver operating characteristic of 0.74 (95% CI: 0.47-0.95) and positive predictive value of 0.97 for LVEF improvement after CA, which was observed in 39 of 47 (83.0%) participants in sinus rhythm.

Conclusions

The RTI in persistent AF was associated with a reduced LVEF, whereas mean heart rate was not. The RTI could be used to predict LVEF improvement after CA.

查看原文本刊更多论文

恢复阈值指数表征心房颤动心室率与射血分数的关系。

背景：左室射血分数（LVEF）降低和频率控制性心房颤动（AF）患者在恢复窦性心律后可能会改善。这可能是由于即使在平均心率可以接受的情况下，房颤期间也消除了短的R-R间隔。目的：本研究旨在评估一个代表房颤期间短R-R间隔负担的新参数及其与导管消融（CA）后LVEF降低和LVEF恢复的关系。方法：持续性房颤患者前瞻性入组ca前，并分为LVEF降低（LVEF≤50%）和LVEF保留两组。测量静息动态心电图的序贯R-R间隔。我们试图定义一个阈值R-R间期，当比较射血分数降低和保留的患者时，短R-R间期百分比的差异最大。我们将这一阈值称为恢复阈值（RT），因为我们相信这可以作为识别af介导的心肌病患者的阈值。这个比RT短的间隔的百分比负担被定义为恢复阈值指数（RTI）。然后评估与房颤LVEF降低的关系以及CA后LVEF改善的预测。结果：入组104例患者；53例（51%）LVEF降低。两组平均心率无差异；然而，在660 ms时，LVEF减小组的RTI更高(56.1%±23.1% vs 39.5%±26.0%；P < 0.001)。它是左室收缩功能障碍的独立预测因子。LVEF减少组的RTI在受者工作特征下的面积为0.74 (95% CI: 0.47-0.95)， CA后LVEF改善的阳性预测值为0.97,47名窦性心律患者中有39名（83.0%）观察到这一点。结论：持续性房颤的RTI与LVEF降低有关，而平均心率则与此无关。RTI可用于预测CA后LVEF的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.