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Fluctuation in Autonomic Tone is a Major Determinant of Sustained Atrial Arrhythmias in Patients with Focal Ectopy Originating from the Pulmonary Veins
Author(s) -
ZIMMERMANN MARC,
KALUSCHE DIETRICH
Publication year - 2001
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2001.00285.x
Subject(s) - medicine , atrial fibrillation , cardiology , vagal tone , heart rate , heart rate variability , autonomic nervous system , anesthesia , blood pressure
Autonomic Variations in Focal AF . Introduction : This study was designed to analyze dynamic changes in autonomic tone preceding the onset of sustained atrial arrhythmias in patients with focal atrial fibrillation (AF) to determine why patients with frequent discharge from the arrhythmogenic foci develop sustained AF. Methods and Results : Holter tapes from 13 patients ( 10 men and 3 women; mean age 53 ± 5 years ) with paroxysmal “lone” AF ( mean 18 ± 13 episodes per week ) and a proven focal origin (pulmonary veins in all cases) were analyzed. A total of 38 episodes of sustained AF (> 30 min) were recorded and submitted to frequency‐domain heart rate variability analysis. Six periods were studied using repeated measures analysis of variance: the 24–hour period, the hour preceding AF, and the 20 minutes before AF divided into four 5–minute periods. A significant increase in high‐frequency (HF, HF‐NU) components was observed during the 20 minutes preceding AF ( P = 0.003 and 0.002 , respectively), together with a progressive decrease in normalized low‐frequency (LF‐NU) components ( P = 0.035 ). An increase in LF/HF ratio followed by a linear decrease starting 15 minutes before sustained AF also was observed, indicating fluctuations in autonomic tone, with a primary increase in adrenergic drive followed by a marked modulation toward vagal predominance immediately before AF onset. Conclusion : In patients with focal ectopy originating from the pulmonary veins, sustained episodes of atrial arrhythmias are mainly dependent on variations of autonomic tone, with a significant shift toward vagal predominance before AF onset.