Atrial Fibrillation: Is it an Additional Risk Factor of Atherosclerosis?
Authors:   Samara State Medical University, Germanova Olga 
Published: May 2021

Aim: To investigate the influence of changes in the parameters of the biomechanics of the heart and the kinetics of the main arteries in different variants of AF on the development and progression of atherosclerosis. Materials and Methods: In the study we included 108 patients (66 men and 42 women). The mean age was 67,3 ± 5,6 years.In anamnesis, special attention was paid to identifying such diseases as myocardial infarction, stroke, diseases caused by the atherosclerosis of the lower extremities arteries. All patients were performed ECG, 24-hours ECG monitoring, transthoracic and transesophageal echocardiography, the lipids blood analysis. If prescribed, it were performed stress echocardiography with physical exercise or dobutamine. The severity of signs of atherosclerotic lesions of the arteries in all patients was determined by the Doppler ultrasound of the brachiocephalic arteries, branches of the aorta, lower extremities arteries, and renal arteries. According to indications, we performed coronary angiography, renal artery angiography. The biomechanics of the heart and the kinetics of the main arteries were measured by Apexcardiography (ACG) and Sphygmography (SG) of the main arteries of different types: common carotid and posterior tibial arteries. This method is used more than 100 years and is very informative, non-invasive method highly correlated with intra-vascular pressure and other hemodynamical parameters. According to the 24-hours ECG monitoring, all patients were divided into 3 main groups. This distribution was based on the maximum pause interval between ventricular contractions in AF. The first group included 34 patients in whom the pause between ventricular contractions did not exceed 1 second. The second group included 36 patients in whom the pause between ventricular contractions was 1-2 seconds. The third group included 38 patients in whom the pause between ventricular contractions was more than 2 seconds. Patients of all groups were homogeneous in age, sex, comorbidity. Results: The incidence of atherosclerotic vascular lesions was higher in group 3 of patients in whom the pause between ventricular contractions in AF exceeded 2 seconds, and the proportion of hemodynamically significant stenoses was also higher in this group.We observed the increase in the main parameters of the heart biomechanics and the kinetics of the main arteries in the first contraction after a long pause between the ventricular contraction in patients with different variants of AF with the following pattern: the longer the pause between the ventricular contraction, the greater the increase in parameters was observed. Conclusion: AF is an additional risk factor for the development and progression of atherosclerosis.Places of greatest impact of the first contraction hydraulic shock after a long pause in AF - bifurcation of the common carotid artery, bifurcation of the aorta, large radius of the aortic arch. That is why the atherosclerotic process is localized in these areas. Prognostically more unfavorable in terms of the development and progression of atherosclerosis is the variant of atrial fibrillation with a pause duration between ventricular contractions of more than 2 seconds.