Promotion of Atrial Fibrillation by Heart Failure in Dogs

TLDR

Atrial fibrillation driven by atrial tachycardia has been studied for its remodeling mechanisms, yet the initial substrate that supports AF before remodeling remains unclear. The study aimed to determine how congestive heart failure influences atrial electrophysiology in dogs and to compare these effects with those produced by rapid atrial pacing. Dogs were subjected to five weeks of rapid ventricular pacing to induce CHF, and their atrial electrophysiology was compared to that of dogs undergoing rapid atrial pacing with a controlled ventricular rate. CHF markedly prolonged AF duration and increased conduction heterogeneity through extensive interstitial fibrosis, thereby promoting sustained AF via a substrate distinct from that of tachycardia‑related AF.

Abstract

Background —Studies of atrial fibrillation (AF) due to atrial tachycardia have provided insights into the remodeling mechanisms by which “AF begets AF” but have not elucidated the substrate that initially supports AF before remodeling occurs. We studied the effects of congestive heart failure (CHF), an entity strongly associated with clinical AF, on atrial electrophysiology in the dog and compared the results with those in dogs subjected to rapid atrial pacing (RAP; 400 bpm) with a controlled ventricular rate (AV block plus ventricular pacemaker at 80 bpm). Methods and Results —CHF induced by 5 weeks of rapid ventricular pacing (220 to 240 bpm) increased the duration of AF induced by burst pacing (from 8±4 seconds in control dogs to 535±82 seconds; P <0.01), similar to the effect of 1 week of RAP (713±300 seconds). In contrast to RAP, CHF did not alter atrial refractory period, refractoriness heterogeneity, or conduction velocity at a cycle length of 360 ms; however, CHF dogs had a substantial increase in the heterogeneity of conduction during atrial pacing (heterogeneity index in CHF dogs, 2.76±0.16 versus 1.46±0.10 for control and 1.51±0.06 for RAP dogs; P <0.01) owing to discrete regions of slow conduction. Histological examination revealed extensive interstitial fibrosis (connective tissue occupying 12.8±1.9% of the cross-sectional area) in CHF dogs compared with control (0.8±0.3%) and RAP (0.9±0.2%) dogs. Conclusions —Experimental CHF strongly promotes the induction of sustained AF by causing interstitial fibrosis that interferes with local conduction. The substrates of AF in CHF are very different from those of atrial tachycardia–related AF, with important potential implications for understanding, treating, and preventing AF related to CHF.