Advanced search
1 file | 700.30 KB

Dynamic filling parameters in patients with atrial fibrillation: differentiating rhythm induced from ventilation-induced variations in pulse pressure

PIET WYFFELS (UGent) , Frederic Van Heuverswyn (UGent) , Stefan De Hert (UGent) and Patrick Wouters (UGent)
Author
Organization
Abstract
In patients with sinus rhythm, the magnitude of mechanical ventilation (MV)-induced changes in pulse pressure (PP) is known to predict the effect of fluid loading on cardiac output. This approach, however, is not applicable in patients with atrial fibrillation (AF). We propose a method to isolate this effect of MV from the rhythm-induced chaotic changes in PP in patients with AF. In 10 patients undergoing pulmonary vein ablation for treatment of AF under general anesthesia, ECG and PP waveforms were analyzed during apnea (T1) and during MV at tidal volumes of 8 ml/kg (T2) and 12 ml/kg (T3), respectively. In a first step, three mathematical models were compared in their ability to predict individual PP at T1. The best-fitting model was then selected as the reference to quantify the effects of MV on PP in these patients. A local polynomial regression model based on two preceding RR intervals (LOC2) was found to be superior over the quadratic models to predict PP. LOC2 was therefore selected to quantify variations in PP induced by MV. During T2 and T3, magnitude of PP deviations was related with the amplitude of tidal volume [mean bias error (SD) of -5 (6) and -8 (7) mmHg for T2 and T3, respectively; P = 0.003 repeated-measures ANOVA]. We conclude that LOC2 most accurately predicted rhythm-induced variations in PP. MV-induced deviations in PP can be quantified and may therefore provide a method to study cardiopulmonary interactions in the presence of arrhythmia.
Keywords
PREDICT FLUID RESPONSIVENESS, fluid responsiveness, HEART-LUNG INTERACTIONS, LOCALLY WEIGHTED REGRESSION, SYSTOLIC VARIATION TEST, TO-BEAT PERFORMANCE, OF-THE-LITERATURE, MECHANICAL VENTILATION, ELECTRICAL CARDIOVERSION, INTRATHORACIC PRESSURE, ARTERIAL-PRESSURE, mechanical ventilation, cardiopulmonary interaction, pulse pressure variation, atrial fibrillation

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 700.30 KB

Citation

Please use this url to cite or link to this publication:

Chicago
WYFFELS, PIET, Frederic Van Heuverswyn, Stefan De Hert, and Patrick Wouters. 2016. “Dynamic Filling Parameters in Patients with Atrial Fibrillation: Differentiating Rhythm Induced from Ventilation-induced Variations in Pulse Pressure.” American Journal of Physiology-heart and Circulatory Physiology 310 (9): H1194–H1200.
APA
WYFFELS, P., Van Heuverswyn, F., De Hert, S., & Wouters, P. (2016). Dynamic filling parameters in patients with atrial fibrillation: differentiating rhythm induced from ventilation-induced variations in pulse pressure. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 310(9), H1194–H1200.
Vancouver
1.
WYFFELS P, Van Heuverswyn F, De Hert S, Wouters P. Dynamic filling parameters in patients with atrial fibrillation: differentiating rhythm induced from ventilation-induced variations in pulse pressure. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY. 2016;310(9):H1194–H1200.
MLA
WYFFELS, PIET et al. “Dynamic Filling Parameters in Patients with Atrial Fibrillation: Differentiating Rhythm Induced from Ventilation-induced Variations in Pulse Pressure.” AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY 310.9 (2016): H1194–H1200. Print.
@article{8052875,
  abstract     = {In patients with sinus rhythm, the magnitude of mechanical ventilation (MV)-induced changes in pulse pressure (PP) is known to predict the effect of fluid loading on cardiac output. This approach, however, is not applicable in patients with atrial fibrillation (AF). We propose a method to isolate this effect of MV from the rhythm-induced chaotic changes in PP in patients with AF. In 10 patients undergoing pulmonary vein ablation for treatment of AF under general anesthesia, ECG and PP waveforms were analyzed during apnea (T1) and during MV at tidal volumes of 8 ml/kg (T2) and 12 ml/kg (T3), respectively. In a first step, three mathematical models were compared in their ability to predict individual PP at T1. The best-fitting model was then selected as the reference to quantify the effects of MV on PP in these patients. A local polynomial regression model based on two preceding RR intervals (LOC2) was found to be superior over the quadratic models to predict PP. LOC2 was therefore selected to quantify variations in PP induced by MV. During T2 and T3, magnitude of PP deviations was related with the amplitude of tidal volume [mean bias error (SD) of -5 (6) and -8 (7) mmHg for T2 and T3, respectively; P = 0.003 repeated-measures ANOVA]. We conclude that LOC2 most accurately predicted rhythm-induced variations in PP. MV-induced deviations in PP can be quantified and may therefore provide a method to study cardiopulmonary interactions in the presence of arrhythmia.},
  author       = {WYFFELS, PIET and Van Heuverswyn, Frederic and De Hert, Stefan and Wouters, Patrick},
  issn         = {0363-6135},
  journal      = {AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY},
  keywords     = {PREDICT FLUID RESPONSIVENESS,fluid responsiveness,HEART-LUNG INTERACTIONS,LOCALLY WEIGHTED REGRESSION,SYSTOLIC VARIATION TEST,TO-BEAT PERFORMANCE,OF-THE-LITERATURE,MECHANICAL VENTILATION,ELECTRICAL CARDIOVERSION,INTRATHORACIC PRESSURE,ARTERIAL-PRESSURE,mechanical ventilation,cardiopulmonary interaction,pulse pressure variation,atrial fibrillation},
  language     = {eng},
  number       = {9},
  pages        = {H1194--H1200},
  title        = {Dynamic filling parameters in patients with atrial fibrillation: differentiating rhythm induced from ventilation-induced variations in pulse pressure},
  url          = {http://dx.doi.org/10.1152/ajpheart.00712.2015},
  volume       = {310},
  year         = {2016},
}

Altmetric
View in Altmetric
Web of Science
Times cited: