Association of induced atrial fibrillation in the electrophysiology laboratory with endothelial dysfunction and documented atrial fibrillation

Abstract

Objective: Atrial fibrillation (AF) is a common arrhythmia that increases morbidity and mortality, as well as healthcare costs. The induction of AF (IAF) during programmed atrial pacing in an electrophysiological study (EPS) is a prevalent phenomenon that has been underappreciated by electrophysiologists. Despite extensive research on AF, only a few studies have focused on this phenomenon. The aim of our study was to investigate the association between history of AF and IAF and the underlying pathophysiological factors such as arterial stiffness, subclinical atherosclerosis, and impaired endothelial function. Methods: This cross-sectional and observational study included 87 patients who had palpitations and were scheduled for EPS. Patients underwent biochemical investigations, transthoracic echocardiography, carotid ultrasound, carotid-femoral artery pulse wave velocity (PWV), and flow-mediated dilatation (FMD) measurements before EPS. Patients were divided into two groups, AF-induced and non-induced in EPS, for further statistical analysis. Results: AF was induced in 16 of 87 patients (18.3%) included in the analysis. The FMD (%) was significantly lower (16.01 ± 10.1 vs. 8.7 ± 5.7, P = 0.022) and, remarkably, the proportion of patients with a history of AF was significantly higher (2.8% vs. 37.5%, P < 0.001) in the IAF group. ROC analysis showed that a documented AF and FMD predicted IAF, with AUC of 0.741 (p = 0.012) and 0.740 (p = 0.001), respectively. Logistic regression analysis revealed that FMD and history of AF were strong predictors of IAF (odds ratio [OR], 0.853; 95% confidence interval [CI] 0.737–0.988; P = 0.034, OR: 10.1, 95% CI 4.9–20.5; P = 0.003, respectively). Conclusion: Endothelial dysfunction and documented AF were associated with IAF during EPS.