Abstract
Both supraventricular and ventricular arrhythmias may occur in patients without relevant epicardial coronary disease, significant structural heart disease or channelopathies. Their underlying mechanism is often unclear, and may sometimes be attributed to a preexistent coronary microvascular dysfunction which facilitates arrhythmias. Furthermore, arrhythmias may promote coronary microvascular dysfunction. We sought to clarify this relationship, starting from a clinical case of atrial fibrillation in a patient with coronary microvascular dysfunction and no epicardial coronary disease. We then explored various clinical scenarios which include ventricular arrhythmias, non-ischemic structural cardiac disease, cardiac pacing, bradyarrhythmias and conduction abnormalities.
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References
Kaski JC. Pathophysiology and management of patients with chest pain and normal coronary arteriograms (cardiac syndrome X). Circulation. 2004;109(5):568–72. https://doi.org/10.1161/01.CIR.0000116601.58103.62.
Pries AR, Habazettl H, Ambrosio G, et al. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings. Cardiovasc Res. 2008;80(2):165–74. https://doi.org/10.1093/cvr/cvn136.
Shaw J, Anderson T. Coronary endothelial dysfunction in non-obstructive coronary artery disease: risk, pathogenesis, diagnosis and therapy. Vasc Med. 2016;21(2):146–55. https://doi.org/10.1177/1358863X15618268.
Di Franco A, Di Monaco A, Lamendola P, et al. Evidence of exclusively silent microvascular ischemia: role of differences in nociceptive function compared to symptomatic microvascular ischemia. Eur Heart J. 2011;32:569.
Jespersen L, Hvelplund A, Abildstrøm SZ, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33(6):734–44. https://doi.org/10.1093/eurheartj/ehr331.
Sharaf B, Wood T, Shaw L, et al. Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored women’s ischemia syndrome evaluation (WISE) angiographic core lab. Am Heart J. 2013;166(1):134–41. https://doi.org/10.1016/j.ahj.2013.04.002.
Wijesurendra RS, Casadei B. Atrial fibrillation: effects beyond the atrium? Cardiovasc Res. 2015;105(3):238–47. https://doi.org/10.1093/cvr/cvv001.
Range FT, Schäfers M, Acil T, et al. Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation. Eur Heart J. 2007;28(18):2223–30. https://doi.org/10.1093/eurheartj/ehm246.
Range FT, Paul M, Schafers KP, et al. Myocardial perfusion in nonischemic dilated cardiomyopathy with and without atrial fibrillation. J Nucl Med. 2009;50(3):390–6. https://doi.org/10.2967/jnumed.108.055665.
Van Den Bos EJ, Constantinescu AA, Van Domburg RT, Akin S, Jordaens LJ, Kofflard MJM. Minor elevations in troponin i are associated with mortality and adverse cardiac events in patients with atrial fibrillation. Eur Heart J. 2011;32(5):611–7. https://doi.org/10.1093/eurheartj/ehq491.
Bukowska A, Hammwöhner M, Sixdorf A, et al. Dronedarone prevents microcirculatory abnormalities in the left ventricle during atrial tachypacing in pigs. Br J Pharmacol. 2012;166(3):964–80. https://doi.org/10.1111/j.1476-5381.2011.01784.x.
Goette A, Bukowska A, Dobrev D, et al. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J. 2009;30(11):1411–20. https://doi.org/10.1093/eurheartj/ehp046.
Lim HS, Willoughby SR, Schultz C, et al. Effect of atrial fibrillation on atrial thrombogenesis in humans: impact of rate and rhythm. J Am Coll Cardiol. 2013;61(8):852–60. https://doi.org/10.1016/j.jacc.2012.11.046.
Lip GYH, Coca A, Kahan T, et al. Hypertension and cardiac arrhythmias: executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Eur Hear J Cardiovasc Pharmacother. 2017;3(4):235–50. https://doi.org/10.1093/ehjcvp/pvx019.
Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart. 2005;91(2):250–6. https://doi.org/10.1136/hrt.2004.042473.
Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med. 2003;349(11):1027–35. https://doi.org/10.1056/NEJMoa025050.
Herrmann J, Kaski JC, Lerman A. Coronary microvascular dysfunction in the clinical setting: from mystery to reality. Eur Heart J. 2012;33(22):2771–82. https://doi.org/10.1093/eurheartj/ehs246.
Möller C, Eitel C, Thiele H, Eitel I, Stiermaier T. Ventricular arrhythmias in patients with Takotsubo syndrome. J Arrhythm. 2018;34(4):369–75.
Gallagher JJ. Tachycardia and cardiomyopathy: the chicken-egg dilemma revisited. J Am Coll Cardiol. 1985;6(5):1172–3. https://doi.org/10.1016/S0735-1097(85)80328-4.
Khasnis A, Jongnarangsin K, Abela G, Veerareddy S, Reddy V, Thakur R. Tachycardia-induced cardiomyopathy: a review of literature. Pacing Clin Electrophysiol. 2005;28(7):710–21. https://doi.org/10.1111/j.1540-8159.2005.00143.x.
Spinale FG, Tanaka R, Crawford FA, Zile MR. Changes in myocardial blood flow during development of and recovery from tachycardia-induced cardiomyopathy. Circulation. 1992;85(2):717–29. https://doi.org/10.1161/01.CIR.85.2.717.
Spinale FG, Grine RC, Tempel GE, Crawford FA, Zile MR. Alterations in the myocardial capillary vasculature accompany tachycardia-induced cardiomyopathy. Basic Res Cardiol. 1992;87(1):65–79. https://doi.org/10.1007/BF00795391.
Tomita M, Ikeguchi S, Kagawa K, et al. Serial histopathologic myocardial findings in a patient with ectopic atrial tachycardia-induced cardiomyopathy. J Cardiol. 1997;29(1):37–42.
Jain AC, Mehta MC. Etiologies of left bundle branch block and correlations with hemodynamic and angiographic findings. Am J Cardiol. 2003;91(11):1375–8. https://doi.org/10.1016/S0002-9149(03)00337-0.
Koepfli P, Wyss CA, Gaemperli O, et al. Left bundle branch block causes relative but not absolute septal underperfusion during exercise. Eur Heart J. 2009;30(24):2993–9. https://doi.org/10.1093/eurheartj/ehp372.
Skalidis EI, Kochiadakis GE, Koukouraki SI, et al. Myocardial perfusion in patients with permanent ventricular pacing and normal coronary arteries. J Am Coll Cardiol. 2001;37(1):124–9. https://doi.org/10.1016/S0735-1097(00)01096-2.
Brown MD, Davies MK, Hudlicka O, et al. Cell Mol Biol Res. 1994;40(2):137–42.
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Vatasescu, R., Bogdan, S., Deaconu, A. (2020). Coronary Microcirculation and Arrhythmias: The Two Faces of a Janus. In: Dorobantu, M., Badimon, L. (eds) Microcirculation. Springer, Cham. https://doi.org/10.1007/978-3-030-28199-1_14
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DOI: https://doi.org/10.1007/978-3-030-28199-1_14
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