Research Article
Volume 7 Issue 10 - 2020
Predictors of Repeated Atrial Fibrillation Paroxism with Patients Having Arterial Hypertension: Analysis of Current Heart Rate Variability and Myocardium Remodeling
Dedov Dmitrii1,2*, Mazayev Vladimir3 and Masyukov Semen4
1Professor, Cardiologist, Department of Disaster Medicine, Tver State Medical University of Ministry of Health of the Russian Federation, Tver, Russia
2Tver Regional Clinical Cardiologic Dispensary, Tver, Russia
3Professor, Cardiologist, National Medical Research Center for Therapy and Preventive Medicine of Ministry of Health of the Russian Federation, Moscow, Russia
4Cardiologist, “Expert” Clinic, Tver, Russia
*Corresponding Author: Dedov Dmitrii, Professor, Cardiologist, Department of Disaster Medicine, Tver State Medical University of Ministry of Health of the Russian Federation, Tver, Russia.
Received: August 17, 2020; Published: September 28, 2020




Abstract

Introduction: The prevalence of arterial hypertension and atrial fibrillation had been increasing in most countries of the world. It is known that modern medicine had the problems of arterial hypertension and atrial fibrillation in the center of its attention. It was associated with the increased risk of cardiovascular complications, loss of productivity and mortality among the patients having these diseases. Autonomic influence on the heart played a large part not only in the trigger mechanism, but also in AF progression. At the same time, the severity of atrial fibrillation course depended on the changes in the structure, mass, geometry, and remodeling of the left ventricle. However, the issues of pathogenetic mechanisms and predictors of recurrent atrial fibrillation with arterial hypertension patients having different variants of left ventricular myocardium remodeling are not fully studied and required more detailed coverage.

Objective of the Study: Study the predictors of recurrent paroxysm of atrial fibrillation according to the data of time and spectral analysis of daily heart rate variability with patients having arterial hypertension and different variants of left ventricular myocardium remodeling.

Materials and Methods: In total, 62 patients were examined (average age 58.9 ± 9.2). They complained of "rapid heartbeat and heart failure" attacks 2 - 3 times a month. 18 patients had no arterial hypertension and paroxysmal atrial fibrillation PAF detected. They were included in the 1st group (average age 57.2 ± 7.5). 44 of the examined men and women had AH and PAF found. They were included in the 2nd group (average age 58.4 ± 8.6). As a result, all the patients from the 2nd group were divided into 3 subgroups: 2A - 24 patients with arterial hypertension, paroxysmal atrial fibrillation and concentric left ventricular hypertrophy; 2B - 12 examined patients with arterial hypertension, paroxysmal atrial fibrillation and eccentric left ventricular hypertrophy; 2C - 8 patients with arterial hypertension, paroxysmal atrial fibrillation and left ventricular dilatation. Paroxysmal atrial fibrillation was recorded on the electrocardiogram (ECG). All the patients underwent Holter monitoring (HM) of ECG. Every patient had his daily heart rate variability (HRV) assessed. All the patients underwent echocardiography (EchoCG) and Doppler EchoCG. The analysis of the obtained indicators was carried out using the application software package “Statistica”. The following descriptive statistics were made. Methods of parametric and non-parametric statistics were used. Qualitative values were estimated using contingency tables and Pearson's chi-squared test (c2) with Yates' correction. To assess the relationship between continuous variables, the Spearman’s rank correlation coefficient rs was used. The significance level of all the statistical tests was accepted as p ˂ 0.05.

Results: It turned out that the examined people from 2A subgroup compared to the patients from the 1st group had their VAR, SDNN and SDANN parameters decreased, while AVNN, PNN50, RMSSD and SDNNIDX parameters, on the contrary, increased. We found that AVNN and RMSSD values with the patients from 2A, 2B and 2C subgroups were higher in contrast to similar HRV parameters with the patients from the 1st group (all p < 0.05). The high risk of recurrent AF paroxysms was associated with the increase in SDNN, SDANN, RMSSD and PNN50 values. Thus, a positive relationship was found between the parameters of the time and spectral analysis of HRV: VAR SDNN, PNN50, RMSSD, SDANN and TF, VLF, LF (rs = 0.47 - 0.97; p = 0.012 - 0.048). We found that HF values with the patients from 2A, 2B and 2C subgroups were higher than in the 1st group (by 2.9; 3.8 and 4.4 times, respectively; all p < 0.01).

Conclusion: Patients with arterial hypertension and concentric left ventricular hypertrophy during the study of daily heart rate variability had repeated PAF associated with the simultaneous disturbance in the balance of the effects of sympathetic and parasympathetic parts of the autonomic nervous system on the heart rate with increased sympathetic stimulation. With the progression of myocardium remodeling in the form of the development of eccentric hypertrophy and left ventricular dilatation, an increase in the activity of parasympathetic nervous system was noted. According to the time and spectral analysis of heart rate variability with patients having arterial hypertension and concentric left ventricular hypertrophy, the decrease in VAR and SDNN values below 805.1 and 116.2 ms, respectively, could be the predictors of recurrent atrial fibrillation paroxysm; patients with arterial hypertension, eccentric hypertrophy or left ventricular dilatation showed the increase in PNN50 and RMMSD values of more than 7.5% and 24.7 ms, respectively. Recurrent atrial fibrillation paroxysm with patients having arterial hypertension, regardless of the variant of left ventricular myocardium remodeling, was associated with the increase in the power of VLF, LF and HF spectral analysis waves above 1132.7 ms2, 446.8 ms2 and 171.8 ms2, respectively.

Keywords: Atrial Fibrillation; Arterial Hypertension; Myocardium Remodeling

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Citation: Dedov Dmitrii., et al. “Predictors of Repeated Atrial Fibrillation Paroxism with Patients Having Arterial Hypertension: Analysis of Current Heart Rate Variability and Myocardium Remodeling”. EC Cardiology 7.10 (2020): 37-44.

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