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Tilt-induced changes in f-wave characteristics during atrial fibrillation : an experimental and computational investigation

Abdollahpur, Mostafa LU ; Celotto, Chiara ; Sánchez, Carlos ; Plappert, Felix LU orcid ; Östenson, Sten ; Platonov, Pyotr G LU ; Laguna, Pablo ; Pueyo, Esther and Sandberg, Frida LU (2025) In Frontiers in Physiology 16.
Abstract

INTRODUCTION: This study explores transient and stationary effects of sympathetic and parasympathetic stimulation on f-wave characteristics in atrial fibrillation (AF) patients undergoing a tilt test. Transient phase is defined as the initial 2-minute interval following each postural change, reflecting immediate autonomic adaptation, whereas steady phase refers to the subsequent interval (from 3 minutes post-change until phase end) representing a stable autonomic state.

METHODS: Our primary aim is to investigate how the two branches of the autonomic nervous system (ANS) influence the f-wave frequency time series (


f

(

m

)


). An analysis of


f... (More)

INTRODUCTION: This study explores transient and stationary effects of sympathetic and parasympathetic stimulation on f-wave characteristics in atrial fibrillation (AF) patients undergoing a tilt test. Transient phase is defined as the initial 2-minute interval following each postural change, reflecting immediate autonomic adaptation, whereas steady phase refers to the subsequent interval (from 3 minutes post-change until phase end) representing a stable autonomic state.

METHODS: Our primary aim is to investigate how the two branches of the autonomic nervous system (ANS) influence the f-wave frequency time series (


f

(

m

)


). An analysis of


f

(

m

)


in terms of the mean over time (




F


f



) and the magnitude of respiration-modulated


f

(

m

)


variations (


Δ


F


f



) is conducted during baseline supine rest (B), head-down tilt (HDT) and head-up tilt (HUT). We analyzed data from a previous study in which 24 patients with persistent AF underwent a tilt test protocol, during which electrocardiograms (ECGs) were recorded. A model-based method was used to extract


f

(

m

)


series from the ECG. Subsequently, an orthogonal subspace projection method was employed to quantify


Δ


F


f



, considering an ECG-derived respiratory signal. Electrophysiological computational simulations were conducted on 2D and 3D human atrial persistent AF models to aid the interpretation of clinical findings. Various levels of cholinergic stimulation by acetylcholine and


β

-adrenergic stimulation by isoproterenol were tested in the models. The temporal modulation of acetylcholine, representing changes associated with respiration, was cyclically modeled using sinusoidal waveforms.

RESULTS: Analysis of the clinical data showed a decrease in




F


f



from B to HDT and an increase from HDT to HUT. During HDT,


Δ


F


f



initially increased in the transient phase before decreasing in the steady phase, then rose again during HUT. Analysis of the simulated data showed that increasing the concentration of Isoproterenol and/or acetylcholine resulted in a rise in




F


f



. Additionally, the magnitude of


Δ


F


f



was shown to be associated with the extent of acetylcholine fluctuation.

DISCUSSION: These results suggest that changes in f-wave frequency characteristics during HUT and HDT could be linked to changes in sympathetic activity, with parasympathetic activity possibly modulating the effects of sympathetic activity rather than being an independent driver of fibrillatory rate changes.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Frontiers in Physiology
volume
16
article number
1498426
publisher
Frontiers Media S. A.
external identifiers
  • pmid:40584873
  • scopus:105009526186
ISSN
1664-042X
DOI
10.3389/fphys.2025.1498426
project
Ph.D. project: Risk stratification and prediction of intervention outcome in AF using novel ECG-based markers of atrial remodelling
Diagnostic Biomarkers in Atrial Fibrillation - Autonomic Nervous System Response as a Sign of Disease Progression
language
English
LU publication?
yes
additional info
Copyright © 2025 Abdollahpur, Celotto, Sánchez, Plappert, Östenson, Platonov, Laguna, Pueyo and Sandberg.
id
cc8285a7-dbde-41bc-be25-e245e4f0c300
date added to LUP
2025-07-07 09:29:05
date last changed
2025-08-11 16:56:01
@article{cc8285a7-dbde-41bc-be25-e245e4f0c300,
  abstract     = {{<p>INTRODUCTION: This study explores transient and stationary effects of sympathetic and parasympathetic stimulation on f-wave characteristics in atrial fibrillation (AF) patients undergoing a tilt test. Transient phase is defined as the initial 2-minute interval following each postural change, reflecting immediate autonomic adaptation, whereas steady phase refers to the subsequent interval (from 3 minutes post-change until phase end) representing a stable autonomic state.</p><p>METHODS: Our primary aim is to investigate how the two branches of the autonomic nervous system (ANS) influence the f-wave frequency time series ( <br>
 <br>
 <br>
 f <br>
 <br>
 ( <br>
 <br>
 m<br>
 <br>
 )<br>
 <br>
 <br>
 ). An analysis of<br>
 <br>
 <br>
 f <br>
 <br>
 ( <br>
 <br>
 m<br>
 <br>
 )<br>
 <br>
 <br>
 in terms of the mean over time ( <br>
 <br>
 <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 ) and the magnitude of respiration-modulated <br>
 <br>
 <br>
 f <br>
 <br>
 ( <br>
 <br>
 m<br>
 <br>
 )<br>
 <br>
 <br>
 variations (<br>
 <br>
 <br>
 Δ <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 ) is conducted during baseline supine rest (B), head-down tilt (HDT) and head-up tilt (HUT). We analyzed data from a previous study in which 24 patients with persistent AF underwent a tilt test protocol, during which electrocardiograms (ECGs) were recorded. A model-based method was used to extract <br>
 <br>
 <br>
 f <br>
 <br>
 ( <br>
 <br>
 m<br>
 <br>
 )<br>
 <br>
 <br>
 series from the ECG. Subsequently, an orthogonal subspace projection method was employed to quantify <br>
 <br>
 <br>
 Δ <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 , considering an ECG-derived respiratory signal. Electrophysiological computational simulations were conducted on 2D and 3D human atrial persistent AF models to aid the interpretation of clinical findings. Various levels of cholinergic stimulation by acetylcholine and <br>
 <br>
 <br>
 β<br>
 <br>
 -adrenergic stimulation by isoproterenol were tested in the models. The temporal modulation of acetylcholine, representing changes associated with respiration, was cyclically modeled using sinusoidal waveforms.<br>
 </p><p>RESULTS: Analysis of the clinical data showed a decrease in <br>
 <br>
 <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 from B to HDT and an increase from HDT to HUT. During HDT, <br>
 <br>
 <br>
 Δ <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 initially increased in the transient phase before decreasing in the steady phase, then rose again during HUT. Analysis of the simulated data showed that increasing the concentration of Isoproterenol and/or acetylcholine resulted in a rise in <br>
 <br>
 <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 . Additionally, the magnitude of <br>
 <br>
 <br>
 Δ <br>
 <br>
 <br>
 F<br>
 <br>
 <br>
 f<br>
 <br>
 <br>
 <br>
 was shown to be associated with the extent of acetylcholine fluctuation.<br>
 </p><p>DISCUSSION: These results suggest that changes in f-wave frequency characteristics during HUT and HDT could be linked to changes in sympathetic activity, with parasympathetic activity possibly modulating the effects of sympathetic activity rather than being an independent driver of fibrillatory rate changes.</p>}},
  author       = {{Abdollahpur, Mostafa and Celotto, Chiara and Sánchez, Carlos and Plappert, Felix and Östenson, Sten and Platonov, Pyotr G and Laguna, Pablo and Pueyo, Esther and Sandberg, Frida}},
  issn         = {{1664-042X}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Physiology}},
  title        = {{Tilt-induced changes in f-wave characteristics during atrial fibrillation : an experimental and computational investigation}},
  url          = {{http://dx.doi.org/10.3389/fphys.2025.1498426}},
  doi          = {{10.3389/fphys.2025.1498426}},
  volume       = {{16}},
  year         = {{2025}},
}