Arterial stiffness and atrial fibrillation: A new and intriguing relationship

Abstract

Atrial fibrillation (AF) and arterial stiffness (AS) greatly increase with age. In elderly patients, AF is often a marker of frailty and is frequently associated with important diseases and complications, such as stroke, heart failure, dementia, chronic obstructive pulmonary disease, pneumonia, acute myocardial infarction and urinary infections. Little is known about the influence of vascular properties on AF. In a first experiment, to verify the existence of a possible association between arrhythmia and vascular properties, we evaluated the Cardio-Ankle Vascular Index (CAVI), a measure of AS, in 33 patients (age: 73 ± 12 years) at 5 h from effective external cardioversion (ECV) of persistent AF. We found that CAVI was a direct independent predictor of left atrial diameter. This association did not exist in a healthy control population (N = 18). In a second experiment, conducted in 31 patients (age: 78 ± 7 years), we studied the possible association between AS and AF after ECV of the arrhythmia. At follow-up (on average at 6 months), we observed the arrhythmia in 48% of cases and found that its presence was directly related to CAVI values and CHA2DS2-VASc score. These findings support the hypothesis that AS could exert a significant role in promoting arrhythmia development and its relapses. If our results are confirmed, CAVI could become a key component in the medical assessment of older, comorbid, AF patients.