Erythrocyte aggregability as a hemodynamic marker in paroxysmal atrial fibrillation

Abstract INTRODUCTION Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with significant morbidity and mortality, affecting 1–2% of the global population. AF is closely associated with thromboembolic complications, particularly stroke. The incidence of thromboembolism in atrial fibrillation is approximately 1.2% to 2.2% per year for stroke or systemic embolism in untreated or poorly treated patients. The paroxysmal form of AF is defined as recurrent episodes of AF that terminate spontaneously within 7 days. Paroxysmal AF is often underdiagnosed and may silently progress to a permanent state. This study aimed to evaluate the impact of paroxysmal AF on erythrocyte aggregability and blood rheology to better understand its pathophysiological effects and implications for clinical management METHODOLOGY A total of 41 patients (mean age 55 ± 7.2 years) were enrolled in this study and compared with 21 paroxysmal AF patients to a control group of 20 healthy volunteers. All participants underwent electrocardiography (ECG) and haemorheological evaluations. A study was done using the “Georgian Technique,” a direct and numerically precise method developed by Georgian scientists, which was conducted in the Department of Rheology and Diagnostic Analytical Services of Beritashvili Center of Experimental Biomedicine, Tbilisi, Georgia. Statistical analysis was performed using SPSS 30.00 to compare rheological parameters before and after rhythm restoration. RESULTS Studies have been conducted during paroxysm and after restoration of sinus rhythm, cardioversion was achieved via electrical stimulation (n=2), electrolyte correction (n=4), or pharmacological treatment with amiodarone (n=15). During paroxysmal AF, the mean erythrocyte aggregation index was 38.04 ± 4.6%, and plasma viscosity was (1.15 ± 0.75 cP). After restoration of sinus rhythm, the aggregation index significantly decreased to 30.62 ± 2.7% (p < 0.05), indicating an improvement in rheological status. However, plasma viscosity showed no statistically significant change (1.1 ± 0.48 cP).CONCLUSION Paroxysmal AF significantly impairs hemorheological properties, particularly erythrocyte aggregability, which may contribute to thrombus formation and embolic risk. Restoration of sinus rhythm improves blood flow characteristics by reducing erythrocyte aggregation. These findings underscore the importance of considering rheological parameters in the management and treatment of AF, and suggest a novel therapeutic target for both cardiology and clinical rheology.