Alterations of atrial electrophysiology induced by electrolyte variations: combined computational and P-wave analysis
| Autor: | Paolo Fabbrini, Maria Rosa Viganò, Simonetta Genovesi, Andrea Stella, Daniela Pogliani, Eleonora Galbiati, Antonio Vincenti, Giuseppe Bonforte, Giulia Fantini, Stefano Severi |
|---|---|
| Přispěvatelé: | Severi S., Pogliani D., Fantini G., Fabbrini P., Viganò M.R., Galbiati E., Bonforte G., Vincenti A., Stella A., Genovesi S., Severi, S, Pogliani, D, Fantini, G, Fabbrini, P, Viganò, M, Galbiati, E, Bonforte, G, Vincenti, A, Stella, A, Genovesi, S |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Atrial action potential Refractory period Water-Electrolyte Imbalance Action Potentials Blood Pressure Cardiomegaly Models Biological Electrocardiography atrial electrophysiology atrial fibrillation P-wave signal averaged haemodislysis electrolytes computational modelling Heart Conduction System Heart Rate Predictive Value of Tests Renal Dialysis Physiology (medical) Internal medicine Atrial Fibrillation Heart rate medicine Humans Magnesium Heart Atria Aged Ultrasonography medicine.diagnostic_test Atrium (architecture) business.industry Sodium Effective refractory period Atrial fibrillation Middle Aged medicine.disease Blood pressure Endocrinology Potassium Cardiology Kidney Failure Chronic Calcium Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | EP Europace. 12:842-849 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/euq042 |
| Popis: | Aims Haemodialysis (HD) therapy represents a unique model to test in vivo, in humans, the effects of changes in plasma ionic concentrations. Episodes of paroxysmal atrial fibrillation (AF) often occur during the treatment. We investigated the effects of HD-induced electrolyte variations on atrial electrophysiology by analysing ECG P-wave duration (PWd), which reflects atrial conduction velocity (CV), and simulated atrial action potential (AP). Methods and results In 20 end-stage renal disease patients PWd (signal-averaged ECG), heart rate (HR), blood pressure, Na(+), K(+), Ca(2+), and Mg(2+) plasma concentrations were measured before and after HD session. The Courtemanche computational model of human atrial myocyte was used to simulate the atrial AP. AP upstroke duration (AP(ud)), AP duration and atrial cell effective refractory period (ERP) were computed. Extracellular electrolyte concentrations and HR were imposed to the average values measured in vivo. HD decreased K(+) (from 4.9 +/- 0.5 to 3.9 +/- 0.4 mmol/L, P < 0.001) and Mg(2+) (0.92 +/- 0.08 to 0.86 +/- 0.05 mmol/L, P < 0.05), and increased Na(+) (139.8 +/- 3.4 to 141.6 +/- 3.1 mmol/L, P < 0.05) and Ca(2+) (1.18 +/- 0.09 to 1.30 +/- 0.07 mmol/L, P < 0.001) plasma concentrations. PWd systematically increased in all the patients after HD (131 +/- 11 to 140 +/- 12 ms, P < 0.001), indicating an intra-atrial conduction slowing. PWd increments were inversely correlated with K(+) variations (R = 0.73, P < 0.01). Model-based analysis indicated an AP(ud) increase (from 2.58 to 2.94 ms) after HD, coherent with experimental observations on PWd, and a reduction of ERP by 12 ms. Conclusion Changes of plasma ionic concentrations may lead to modifications of atrial electrophysiology that can favour AF onset, namely a decrease of atrial CV and a decrease of atrial ERP. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|