Both beat-to-beat changes in RR-interval and left ventricular filling time determine ventricular function during atrial fibrillation

Aurore Lyon*, Manouk van Mourik, Laura Cruts, Jordi Heijman, Sebastiaan C. A. M. Bekkers, Ulrich Schotten, Harry J. G. M. Crijns, Dominik Linz, Joost Lumens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims The irregular atrial electrical activity during atrial fibrillation (AF) is associated with a variable left ventricular (LV) systolic function. The mechanisms determining LV function during AF remain incompletely understood. We aimed at elucidating how changes in RR-interval and LV preload affect LV function during AF.

Methods and results Beat-to-beat speckle-tracking echocardiography was performed in 10 persistent AF patients. We evaluated the relation between longitudinal LV peak strain and preceding RR-interval during AF. We used the CircAdapt computational model to evaluate beat-to-beat preload and peak strain during AF for each patient by imposing the patient-specific RR-interval sequences and a non-contractile atrial myocardium. Generic simulations with artificial RRinterval sequences quantified the haemodynamic changes induced by sudden irregular beats. Clinical data and simulations both showed a larger sensitivity of peak strain to changes in preceding RR-interval at slow heart rate (HR) (cycle length, CL

Conclusions During AF, longitudinal LV peak strain is highly variable, particularly at fast HR. Beat-to-beat changes in preload explain the differences in LV systolic function. Simulations revealed that a reduced diastolic LV filling time can explain the increased variability at fast HR.

Original languageEnglish
Pages (from-to)I21-I28
Number of pages8
JournalEP Europace
Publication statusPublished - Mar 2021


  • Atrial fibrillation
  • Speckle-tracking echocardiography
  • Left ventricular function
  • Computer simulations
  • Haemodynamics

Cite this