Hemodynamic changes after atrial fibrillation initiation in patients eligible for catheter ablation: A randomized controlled study

Abstract Aims Atrial fibrillation (AF) hemodynamics is less well studied due to challenges explained by the nature of AF. Until now, no randomized data have been available. This study evaluated hemodynamic variables after AF induction in a randomized setting. Methods and Results Forty-two patients with AF who had been referred for ablation to the University Hospital, Linköping, Sweden, and had no arrhythmias during the four-day screening period were randomized to AF induction versus control (2:1). AF was induced by burst pacing after baseline intracardiac pressure measurements. Pressure changes in the right and left atrium (RA and LA), right ventricle (RV), and systolic and diastolic blood pressures (SBP and DBP) were evaluated 30 minutes after AF induction compared to the control group. Eleven women and 31 men (median age 60) with similar baseline characteristics were included (intervention n=27, control group n=15). After 30 minutes in AF, the RV end-diastolic pressure (RVEDP) and RV systolic pressure (RVSP) were significantly reduced compared with baseline and between randomization groups (RVEDP: P=0.016; RVSP: P=0.001). AF induction increased DBP in the intervention group compared to the control group (P=0.02), unlike reactions in SBP (P=0.178). RA and LA mean pressure (RAm and LAm) responses did not differ significantly between groups (RAm: P=0.307 LAm: P=0.784). Conclusions Induced AF increased DBP, decreased RVEDP, and RVSP. Our results allow us to understand some paroxysmal AF hemodynamics, which provides a hemodynamical rationale to support rhythm regulatory strategies to improve symptoms and outcomes. Trial registration number (clinicaltrials.gov): No NCT01553045 https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1