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Autonomic influence on atrial fibrillatory process : Head-up and head-down tilting

Östenson, Sten; Corino, Valentina D A; Carlsson, Jonas and Platonov, Pyotr G. LU (2016) In Annals of Noninvasive Electrocardiology
Abstract

Background: Changes in the autonomic nervous system (ANS) tone are present before, during, and after episodes of atrial fibrillation (AF). Atrial fibrillatory rate (AFR, the inverse of the atrial cycle length) has been used as a surrogate marker for local refractoriness and is a key characteristic of the fibrillatory process in patients with AF. Aim of this study is to assess changes in AFR, as an effect of autonomic balance change. Methods: Forty patients undergoing cardiac cardioversion for symptomatic persistent AF were included in the study. Surface ECG was recorded during rest, head-down (HDT, -30°), and head-up tilt (HUT, +60°). A median value of AFR was computed in each phase of the protocol. Results: AFR decreased during HDT... (More)

Background: Changes in the autonomic nervous system (ANS) tone are present before, during, and after episodes of atrial fibrillation (AF). Atrial fibrillatory rate (AFR, the inverse of the atrial cycle length) has been used as a surrogate marker for local refractoriness and is a key characteristic of the fibrillatory process in patients with AF. Aim of this study is to assess changes in AFR, as an effect of autonomic balance change. Methods: Forty patients undergoing cardiac cardioversion for symptomatic persistent AF were included in the study. Surface ECG was recorded during rest, head-down (HDT, -30°), and head-up tilt (HUT, +60°). A median value of AFR was computed in each phase of the protocol. Results: AFR decreased during HDT compared to the baseline (B) condition in all patients but three (median AFR_B = 391 fpm vs. AFR_HDT = 377 fpm, p < .0001). HUT increased AFR, making it significantly higher than HDT and baseline conditions (median AFR_HUT = 396 fpm, p < .0001 vs. B and HDT). Heart rate (HR) increased during HUT, but had a heterogeneous behavior in the population during HDT: about one third of the patients had an HR lower during HDT than during baseline, whereas the remaining two third had an increase in HR during HDT. Conclusions: Dominant sympathetic/vagal tone during HUT/HDT significantly affects AFR, increasing/decreasing in respect to baseline. It may be worth exploring the possibility that patients with AF of shorter duration can convert to sinus rhythm during HDT.

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author
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Atrial fibrillation, Atrial fibrillatory rate, Autonomic nervous system, Head-down tilt, Head-up tilt
in
Annals of Noninvasive Electrocardiology
publisher
Wiley-Blackwell
external identifiers
  • Scopus:84988038551
ISSN
1082-720X
DOI
10.1111/anec.12405
language
English
LU publication?
yes
id
5465fb47-5197-494c-ac48-983a15eb79bc
date added to LUP
2016-10-07 11:04:52
date last changed
2016-10-20 10:59:34
@misc{5465fb47-5197-494c-ac48-983a15eb79bc,
  abstract     = {<p>Background: Changes in the autonomic nervous system (ANS) tone are present before, during, and after episodes of atrial fibrillation (AF). Atrial fibrillatory rate (AFR, the inverse of the atrial cycle length) has been used as a surrogate marker for local refractoriness and is a key characteristic of the fibrillatory process in patients with AF. Aim of this study is to assess changes in AFR, as an effect of autonomic balance change. Methods: Forty patients undergoing cardiac cardioversion for symptomatic persistent AF were included in the study. Surface ECG was recorded during rest, head-down (HDT, -30°), and head-up tilt (HUT, +60°). A median value of AFR was computed in each phase of the protocol. Results: AFR decreased during HDT compared to the baseline (B) condition in all patients but three (median AFR_B = 391 fpm vs. AFR_HDT = 377 fpm, p &lt; .0001). HUT increased AFR, making it significantly higher than HDT and baseline conditions (median AFR_HUT = 396 fpm, p &lt; .0001 vs. B and HDT). Heart rate (HR) increased during HUT, but had a heterogeneous behavior in the population during HDT: about one third of the patients had an HR lower during HDT than during baseline, whereas the remaining two third had an increase in HR during HDT. Conclusions: Dominant sympathetic/vagal tone during HUT/HDT significantly affects AFR, increasing/decreasing in respect to baseline. It may be worth exploring the possibility that patients with AF of shorter duration can convert to sinus rhythm during HDT.</p>},
  author       = {Östenson, Sten and Corino, Valentina D A and Carlsson, Jonas and Platonov, Pyotr G.},
  issn         = {1082-720X},
  keyword      = {Atrial fibrillation,Atrial fibrillatory rate,Autonomic nervous system,Head-down tilt,Head-up tilt},
  language     = {eng},
  publisher    = {ARRAY(0x4e0ecc8)},
  series       = {Annals of Noninvasive Electrocardiology},
  title        = {Autonomic influence on atrial fibrillatory process : Head-up and head-down tilting},
  url          = {http://dx.doi.org/10.1111/anec.12405},
  year         = {2016},
}