Effect of atrial fibrillation on atrial thrombogenesis in humans: impact of rate and rhythm

We sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm. Although AF is known to increase the risk of thromboembolic stroke from the left atrium (LA), the exact mechanisms remain poorly understood. We studied 55 patie...

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Vydáno v:Journal of the American College of Cardiology Ročník 61; číslo 8; s. 852
Hlavní autoři: Lim, Han S, Willoughby, Scott R, Schultz, Carlee, Gan, Cheryl, Alasady, Muayad, Lau, Dennis H, Leong, Darryl P, Brooks, Anthony G, Young, Glenn D, Kistler, Peter M, Kalman, Jonathan M, Worthley, Matthew I, Sanders, Prashanthan
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 26.02.2013
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ISSN:1558-3597, 1558-3597
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Abstract We sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm. Although AF is known to increase the risk of thromboembolic stroke from the left atrium (LA), the exact mechanisms remain poorly understood. We studied 55 patients with AF who underwent catheter ablation while in sinus rhythm; 20 patients were induced into AF, 20 patients were atrial paced at 150 beats/min, and 15 were control patients. Blood samples were taken from the LA, right atrium, and femoral vein at baseline and at 15 min in all 3 groups. Platelet activation (P-selectin) was measured by flow cytometry. Thrombin generation (thrombin-antithrombin [TAT] complex), endothelial dysfunction (asymmetric dimethylarginine [ADMA]), and platelet-derived inflammation (soluble CD40 ligand [sCD40L]) were measured using enzyme-linked immunosorbent assay. Platelet activation increased significantly in both the AF (p < 0.001) and pacing (p < 0.05) groups, but decreased in control patients (p < 0.001). Thrombin generation increased specifically in the LA compared with the periphery in both the AF (p < 0.01) and pacing (p < 0.01) groups, but decreased in control patients (p < 0.001). With AF, ADMA (p < 0.01) and sCD40L (p < 0.001) levels increased significantly at all sites, but were unchanged with pacing (ADMA, p = 0.5; sCD40L, p = 0.8) or in control patients (ADMA, p = 0.6; sCD40L, p = 0.9). Rapid atrial rates and AF in humans both result in increased platelet activation and thrombin generation. Prothrombotic activation occurs to a greater extent in the human LA compared with systemic circulation. AF additionally induces endothelial dysfunction and inflammation. These findings suggest that although rapid atrial rates increase the thrombogenic risk, AF may further potentiate this risk.
AbstractList We sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm.OBJECTIVESWe sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm.Although AF is known to increase the risk of thromboembolic stroke from the left atrium (LA), the exact mechanisms remain poorly understood.BACKGROUNDAlthough AF is known to increase the risk of thromboembolic stroke from the left atrium (LA), the exact mechanisms remain poorly understood.We studied 55 patients with AF who underwent catheter ablation while in sinus rhythm; 20 patients were induced into AF, 20 patients were atrial paced at 150 beats/min, and 15 were control patients. Blood samples were taken from the LA, right atrium, and femoral vein at baseline and at 15 min in all 3 groups. Platelet activation (P-selectin) was measured by flow cytometry. Thrombin generation (thrombin-antithrombin [TAT] complex), endothelial dysfunction (asymmetric dimethylarginine [ADMA]), and platelet-derived inflammation (soluble CD40 ligand [sCD40L]) were measured using enzyme-linked immunosorbent assay.METHODSWe studied 55 patients with AF who underwent catheter ablation while in sinus rhythm; 20 patients were induced into AF, 20 patients were atrial paced at 150 beats/min, and 15 were control patients. Blood samples were taken from the LA, right atrium, and femoral vein at baseline and at 15 min in all 3 groups. Platelet activation (P-selectin) was measured by flow cytometry. Thrombin generation (thrombin-antithrombin [TAT] complex), endothelial dysfunction (asymmetric dimethylarginine [ADMA]), and platelet-derived inflammation (soluble CD40 ligand [sCD40L]) were measured using enzyme-linked immunosorbent assay.Platelet activation increased significantly in both the AF (p < 0.001) and pacing (p < 0.05) groups, but decreased in control patients (p < 0.001). Thrombin generation increased specifically in the LA compared with the periphery in both the AF (p < 0.01) and pacing (p < 0.01) groups, but decreased in control patients (p < 0.001). With AF, ADMA (p < 0.01) and sCD40L (p < 0.001) levels increased significantly at all sites, but were unchanged with pacing (ADMA, p = 0.5; sCD40L, p = 0.8) or in control patients (ADMA, p = 0.6; sCD40L, p = 0.9).RESULTSPlatelet activation increased significantly in both the AF (p < 0.001) and pacing (p < 0.05) groups, but decreased in control patients (p < 0.001). Thrombin generation increased specifically in the LA compared with the periphery in both the AF (p < 0.01) and pacing (p < 0.01) groups, but decreased in control patients (p < 0.001). With AF, ADMA (p < 0.01) and sCD40L (p < 0.001) levels increased significantly at all sites, but were unchanged with pacing (ADMA, p = 0.5; sCD40L, p = 0.8) or in control patients (ADMA, p = 0.6; sCD40L, p = 0.9).Rapid atrial rates and AF in humans both result in increased platelet activation and thrombin generation. Prothrombotic activation occurs to a greater extent in the human LA compared with systemic circulation. AF additionally induces endothelial dysfunction and inflammation. These findings suggest that although rapid atrial rates increase the thrombogenic risk, AF may further potentiate this risk.CONCLUSIONSRapid atrial rates and AF in humans both result in increased platelet activation and thrombin generation. Prothrombotic activation occurs to a greater extent in the human LA compared with systemic circulation. AF additionally induces endothelial dysfunction and inflammation. These findings suggest that although rapid atrial rates increase the thrombogenic risk, AF may further potentiate this risk.
We sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm. Although AF is known to increase the risk of thromboembolic stroke from the left atrium (LA), the exact mechanisms remain poorly understood. We studied 55 patients with AF who underwent catheter ablation while in sinus rhythm; 20 patients were induced into AF, 20 patients were atrial paced at 150 beats/min, and 15 were control patients. Blood samples were taken from the LA, right atrium, and femoral vein at baseline and at 15 min in all 3 groups. Platelet activation (P-selectin) was measured by flow cytometry. Thrombin generation (thrombin-antithrombin [TAT] complex), endothelial dysfunction (asymmetric dimethylarginine [ADMA]), and platelet-derived inflammation (soluble CD40 ligand [sCD40L]) were measured using enzyme-linked immunosorbent assay. Platelet activation increased significantly in both the AF (p < 0.001) and pacing (p < 0.05) groups, but decreased in control patients (p < 0.001). Thrombin generation increased specifically in the LA compared with the periphery in both the AF (p < 0.01) and pacing (p < 0.01) groups, but decreased in control patients (p < 0.001). With AF, ADMA (p < 0.01) and sCD40L (p < 0.001) levels increased significantly at all sites, but were unchanged with pacing (ADMA, p = 0.5; sCD40L, p = 0.8) or in control patients (ADMA, p = 0.6; sCD40L, p = 0.9). Rapid atrial rates and AF in humans both result in increased platelet activation and thrombin generation. Prothrombotic activation occurs to a greater extent in the human LA compared with systemic circulation. AF additionally induces endothelial dysfunction and inflammation. These findings suggest that although rapid atrial rates increase the thrombogenic risk, AF may further potentiate this risk.
Author Brooks, Anthony G
Lau, Dennis H
Young, Glenn D
Kistler, Peter M
Willoughby, Scott R
Leong, Darryl P
Schultz, Carlee
Sanders, Prashanthan
Gan, Cheryl
Lim, Han S
Alasady, Muayad
Worthley, Matthew I
Kalman, Jonathan M
Author_xml – sequence: 1
  givenname: Han S
  surname: Lim
  fullname: Lim, Han S
  organization: Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
– sequence: 2
  givenname: Scott R
  surname: Willoughby
  fullname: Willoughby, Scott R
– sequence: 3
  givenname: Carlee
  surname: Schultz
  fullname: Schultz, Carlee
– sequence: 4
  givenname: Cheryl
  surname: Gan
  fullname: Gan, Cheryl
– sequence: 5
  givenname: Muayad
  surname: Alasady
  fullname: Alasady, Muayad
– sequence: 6
  givenname: Dennis H
  surname: Lau
  fullname: Lau, Dennis H
– sequence: 7
  givenname: Darryl P
  surname: Leong
  fullname: Leong, Darryl P
– sequence: 8
  givenname: Anthony G
  surname: Brooks
  fullname: Brooks, Anthony G
– sequence: 9
  givenname: Glenn D
  surname: Young
  fullname: Young, Glenn D
– sequence: 10
  givenname: Peter M
  surname: Kistler
  fullname: Kistler, Peter M
– sequence: 11
  givenname: Jonathan M
  surname: Kalman
  fullname: Kalman, Jonathan M
– sequence: 12
  givenname: Matthew I
  surname: Worthley
  fullname: Worthley, Matthew I
– sequence: 13
  givenname: Prashanthan
  surname: Sanders
  fullname: Sanders, Prashanthan
BackLink https://www.ncbi.nlm.nih.gov/pubmed/23333141$$D View this record in MEDLINE/PubMed
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References 23603696 - J Am Coll Cardiol. 2013 Jul 9;62(2):167-8
23603704 - J Am Coll Cardiol. 2013 Jul 9;62(2):167
23333144 - J Am Coll Cardiol. 2013 Feb 26;61(8):861-2
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Snippet We sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm. Although AF is...
We sought to assess the effect of atrial fibrillation (AF) on atrial thrombogenesis in humans by determining the impact of rate and rhythm.OBJECTIVESWe sought...
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StartPage 852
SubjectTerms Aged
Antithrombin III - metabolism
Arginine - analogs & derivatives
Arginine - metabolism
Atrial Fibrillation - blood
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Catheter Ablation - methods
CD40 Ligand - metabolism
Enzyme Inhibitors - metabolism
Enzyme-Linked Immunosorbent Assay - methods
Female
Heart Atria - metabolism
Heart Atria - physiopathology
Heart Rate
Humans
Male
Middle Aged
P-Selectin - metabolism
Peptide Hydrolases - metabolism
Platelet Activation
Risk Assessment
Risk Factors
Statistics as Topic
Stroke - etiology
Stroke - prevention & control
Thrombosis - blood
Thrombosis - etiology
Thrombosis - physiopathology
Thrombosis - prevention & control
Title Effect of atrial fibrillation on atrial thrombogenesis in humans: impact of rate and rhythm
URI https://www.ncbi.nlm.nih.gov/pubmed/23333141
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Volume 61
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