Heart rate variability and early recurrence of atrial fibrillation after electrical cardioversion

Lombardi, Federico; Colombo, Andrea; Basilico, Barbara; Ravaglia, R; Garbin, M.; Vergani, D; Battezzati, Pier Maria; Fiorentini, Cesare

doi:10.1016/s0735-1097(00)01039-1

Cited by 115 publications

(76 citation statements)

References 31 publications

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“…31,32) Limitations: The limitations of this study are as follows. First, it was a retrospective observational investigation and therefore there was bias in the patient background factors.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between the Long-Term Preventive Effect of Combined Treatment With Antiarrhythmic Drugs Plus Angiotensin-Converting Enzyme Inhibitors and Circadian Variation in the Onset of Paroxysmal Atrial Fibrillation

et al. 2010

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SummaryWe examined the relationship between the efficacy of combined treatment with antiarrhythmic drugs (AAD) plus enalapril for maintaining sinus rhythm and circadian variation in the onset of paroxysmal AF.Three hundred and forty-four patients with paroxysmal AF (239 men, mean age, 69 ± 11 years) who could be followed up ≥ 12 months were divided into 3 groups on the basis of circadian variation in the onset of AF: a diurnal group (7:00 AM-5:00 PM, n = 57), a nocturnal group (5:00 PM-7:00 AM, n = 108), and a mixed group (onset during both periods, n = 169). The maintenance rate of sinus rhythm during the follow-up period was compared between combined therapy (AAD plus enalapril) and AAD alone.In the diurnal group, the maintenance rates of sinus rhythm at 12, 36, 60, and 90 months were 100%, 100%, 100%, and 100%, respectively, for patients treated with AAD plus enalapril (n = 22) versus 97%, 91%, 89%, and 80% for patients treated with AAD alone (n = 35, P < 0.05). In the nocturnal group, the maintenance rates of sinus rhythm at 12, 36, 60, and 90 months were 96%, 96%, 96%, and 92%, respectively, in patients treated with AAD plus enalapril (n = 24) versus 100%, 100%, 100%, and 100% in patients treated with AAD alone (n = 84, P = NS). In the mixed group, maintenance rates of sinus rhythm at 12, 36, 60, and 90 months were 90%, 71%, 61%, and 57%, respectively, in patients treated with AAD plus enalapril (n = 49) versus 88%, 78%, 68%, and 61% in patients treated with AAD alone (n = 120, P = NS).Our findings suggest that the preventive efficacy of combined therapy with AAD plus enalapril is dependent on the timing of onset of paroxysmal AF, and this regimen seems to be most beneficial for the diurnal type of paroxysmal AF. The number of patients with AF in the United States exceeded 5 million in 2000 and is expected to increase two to threefold over the next 50 years.2) In Japan, the population is aging rapidly and the prevalence of AF among elderly persons aged 70 years or older is already around 3%. This is expected to increase to about 4.5% over the next 20 years.3) Antiarrhythmic drug (AAD) therapy for the maintenance of sinus rhythm in patients with AF has limitations. 4) Accordingly, attention has recently been paid to upstream treatment, in which AAD therapy is combined with renin-angiotensin-aldosterone system (RAAS) inhibitors 5,6) or statins 7) to modify the arrhythmic substrate of the atrial myocardium which is the underlying cause of AF. In a recent large clinical trial, however, additional treatment with angiotensin II-receptor blockers (ARB) to AAD was not associated with a reduction in the incidence of recurrent atrial fibrillation.8) It is still not clear which clinical profile of paroxysmal AF benefits from the addition of RAAS inhibitor therapy as an upstream treatment.We report on the results of our investigation into the longterm preventive effect of combined treatment with enalapril, an angiotensin-converting enzyme inhibitor (ACEI), plus AAD therapy in relation to circadian variation in the onse...

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“…31,32) Limitations: The limitations of this study are as follows. First, it was a retrospective observational investigation and therefore there was bias in the patient background factors.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between the Long-Term Preventive Effect of Combined Treatment With Antiarrhythmic Drugs Plus Angiotensin-Converting Enzyme Inhibitors and Circadian Variation in the Onset of Paroxysmal Atrial Fibrillation

et al. 2010

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“…Lombardi F et al showed that the LF/HF obtained from heart rate variability analyses 4 to 5 hours after electrical cardioversion was useful to predict the short-term recurrence of PAf, and insisted that autonomic activity was closely related to PAf recurrence around 2 weeks after cardioversion. 7) Puglisi A et al evaluated the suppressive effect of three kinds of pacemaker rate-responsive algorithms on PAf, including conventional response, overdrive pacing and CLS modes, and found that the CLS mode effectively suppressed PAf for 4 and 7 months after PMI. 6) They inferred that turbulent autonomic Figure 2 Memory data obtained from pacemaker Based on memory data obtained from pacemaker clinic, the rates of ventricular and atrial pacing and atrial sensing more rapid than 150 bpm as surrogate marker of atrial fibrillation are shown.…”

Section: Discussionmentioning

confidence: 99%

Prompt and Long-term Prophylactic Effect of Closed Loop Stimulation against Paroxysmal Atrial Fibrillation in a Patient with Sick Sinus Syndrome

et al. 2009

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A 72-year-old woman with sick sinus syndrome (SSS), who had frequent paroxysmal atrial fibrillations (PAfs) and normal cardiac function, was admitted to our hospital due to syncope. PAfs frequently occurred during the first week after DDD pacemaker implantation (PMI), with closed loop stimulation (CLS) rate-adaptive mode off, but were completely suppressed during the second week, with CLS on, and had been well-controlled over three years thereafter. However, PAfs occasionally occurred under intense sympathetic activity during 6 months after PMI as well, and were effectively terminated by disopyramide which had anticholinergic effect. Thus, the development and maintenance of PAf were thought to be associated with destabilized cardiac autonomic activities, that is, sympathetic and parasympathetic dominance, respectively. Additionally, heart rate variability analyses after implementation of CLS revealed the restoration of sympathetic and parasympathetic components. Accordingly, CLS mode was considered to play a critical role in preventing PAf by reflecting autonomic activity in heart rhythm in this SSS patient. (J Arrhythmia 2009; 25: 158-164)

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“…3,4 Of interest, even excessive slowing of the heart rate by intense VNS is not sufficient to initiate AF; however, the occurrence of spontaneous or induced atrial premature depolarization or burst pacing in the presence of VNS invariably initiates the arrhythmia. 5,6 There are reports in the basic literature 7,8 as well as in clinical reports 9,10 suggesting that vagal activation can be antiarrhythmic. Tai et al 9 reported that focal firing from the pulmonary veins (PVs) in patients with AF was suppressed by intravenous administration of phenylephrine, possibly through increased vagal tone caused by baroreflex activation.…”

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confidence: 99%

Low-Level Vagosympathetic Stimulation

Scherlag

et al. 2009

Circ: Arrhythmia and Electrophysiology

108

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Background-We used high-frequency stimulation delivered during the refractory period of the atrium and pulmonary veins (PVs) to induce focal firing and atrial fibrillation (AF). This study was designed to demonstrate that bilateral low-level vagosympathetic nerve stimulation (LL-VNS) could suppress high-frequency stimulation-induced focal AF at atrial and PV sites. Methods and Results-In 23 dogs anesthetized with Na-pentobarbital, electrodes in the vagosympathetic trunks allowed LL-VNS at 1 V below that which slowed the sinus rate or atrioventricular conduction. Multielectrode catheters were fixed at the right and left superior and inferior PVs and both atrial appendages. LL-VNS continued for 3 hours.

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Heart rate variability and early recurrence of atrial fibrillation after electrical cardioversion

Abstract: Two weeks later, 25 patients presented with AF. Spectral analysis of HRV revealed that patients wi

Cited by 115 publications

References 31 publications

Relationship Between the Long-Term Preventive Effect of Combined Treatment With Antiarrhythmic Drugs Plus Angiotensin-Converting Enzyme Inhibitors and Circadian Variation in the Onset of Paroxysmal Atrial Fibrillation

Relationship Between the Long-Term Preventive Effect of Combined Treatment With Antiarrhythmic Drugs Plus Angiotensin-Converting Enzyme Inhibitors and Circadian Variation in the Onset of Paroxysmal Atrial Fibrillation

Prompt and Long-term Prophylactic Effect of Closed Loop Stimulation against Paroxysmal Atrial Fibrillation in a Patient with Sick Sinus Syndrome

Low-Level Vagosympathetic Stimulation

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