Autonomic modulation of ventricular rate in atrial fibrillation

This study investigated the changes in R-R interval in 23 patients (11 men and 12 women; mean age 61 yr) with persistent atrial fibrillation in response to several provocative maneuvers including active postural change, Valsalva maneuver, handgrip, and rhythm-controlled respiration. Averaged R-R intervals were shortened immediately after postural change (from 797 +/- 35 ms supine to 677 +/- 27 ms standing; P < 0.01) and recovered to the 90% level within 100 s. During Valsalva strain and handgrip, mean R-R intervals were significantly shortened (from 737 +/- 37 ms sitting to 697 +/- 38 ms in Valsalva and from 773 +/- 68 ms sitting to 701 +/- 58 ms in handgrip; both P < 0.01). During rhythm-controlled respiration, only two cases (10.5%) showed power peaks in spectrograms of moving-window-averaged R-R intervals at the frequency corresponding to respiration rhythm. The ventricular response to atrial fibrillation is influenced by an increase in sympathetic tone and a decrease in parasympathetic tone but is not necessarily influenced by the increase in parasympathetic dominance. These results suggest that even in atrial fibrillation patients, the autonomic nervous system modulates the ventricular rate via the atrioventricular node and atrial tissue.

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2699 Relationship of autonomic modulation to early recurrences following internal cardioversion of persistent atrial fibrillation

European Heart Journal ◽

10.1016/s0195-668x(03)95481-9 ◽

2003 ◽

Vol 24 (5) ◽

pp. 500

Author(s):

H MAVRAKIS

Keyword(s):

Atrial Fibrillation ◽

Persistent Atrial Fibrillation ◽

Autonomic Modulation ◽

Internal Cardioversion ◽

Relationship Of

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Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

BMJ Open Quality ◽

10.1136/bmjoq-2020-001270 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001270

Author(s):

Jonathan James Hyett Bray ◽

Elin Fflur Lloyd ◽

Firdaus Adenwalla ◽

Sarah Kelly ◽

Kathie Wareham ◽

...

Keyword(s):

Atrial Fibrillation ◽

Community Setting ◽

Cost Effective ◽

Ventricular Rate ◽

Service Improvement ◽

Community Monitoring ◽

Ventricular Response ◽

Community Diagnosis ◽

New Onset

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

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GW28-e1217 Ventricular rate existing circadian pattern in patients with persistent atrial fibrillation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.07.641 ◽

2017 ◽

Vol 70 (16) ◽

pp. C175

Author(s):

Jinxiu Zhu ◽

Nan Lu ◽

Xilie Lu ◽

Xuerui Tan

Keyword(s):

Atrial Fibrillation ◽

Persistent Atrial Fibrillation ◽

Ventricular Rate ◽

Circadian Pattern

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Role of atrial arrhythmia and ventricular response in atrial fibrillation induced atrial remodelling

Cardiovascular Research ◽

10.1093/cvr/cvaa007 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jean-Baptiste Guichard ◽

Feng Xiong ◽

Xiao-Yan Qi ◽

Nathalie L’Heureux ◽

Roddy Hiram ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular ◽

Atrial Arrhythmia ◽

Ventricular Rate ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction ◽

Arrhythmogenic Substrate ◽

Atrial Remodelling ◽

Ventricular Response

Abstract Aims No studies have assessed the specific contributions of atrial fibrillation (AF)-related atrial vs. associated ventricular arrhythmia to remodelling. This study assessed the roles of atrial arrhythmia vs. high ventricular rate in AF-associated remodelling. Methods and results Four primary dog-groups (12/group) were subjected to 3-week pacing: 600-b.p.m. atrial tachypacing maintaining AF [AF w/o- atrioventricular block (AVB)]; atrial tachypacing with atrioventricular-node ablation (AF+AVB) and ventricular-demand pacing (80 b.p.m.); 160-b.p.m. ventricular-tachypacing (V160) reproducing the response rate during AF; and sinus rhythm with AVB/ventricular-pacing at 80-b.p.m. (control group). At terminal study, left-atrial (LA) effective refractory period (ERP) was reduced equally in both AF groups (w/o-AVB and AF+AVB). AF-inducibility was increased strongly in AF groups (w/o-AVB and AF+AVB) and modestly in V160. AF duration was significantly increased in AF w/o-AVB but not in AF+AVB or V160. Conduction velocity was decreased in AF w/o-AVB, to a greater extent than in AF+AVB and V160. Atrial fibrous-tissue content was increased in AF w/o-AVB, AF+AVB and V160, with collagen-gene up-regulation only in AF w/o-AVB. Connexin43 gene expression was reduced only in AF w/o-AVB. An additional group of 240-b.p.m. ventricular tachypacing dogs (VTP240; to induce heart failure) was studied: vs. other tachypaced groups, VTP240 caused greater fibrosis, but no change in LA-ERP or AF-inducibility. VTP240 also increased AF duration, strongly decreased left ventricular ejection fraction, and was the only group with LA natriuretic-peptide activation. Conclusion The atrial tachyarrhythmia and rapid ventricular response during AF produce distinct atrial remodelling; both contribute to the arrhythmogenic substrate, providing new insights into AF-related remodelling and novel considerations for ventricular rate-control.

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Management strategies for atrial fibrillation and flutter in patients with transthyretin cardiac amyloidosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.1810 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Z Dale ◽

P Chandrashekar ◽

L Al-Rashdan ◽

M Kim ◽

A Masri ◽

...

Keyword(s):

Atrial Fibrillation ◽

Rate Control ◽

Cardiac Amyloidosis ◽

Control Strategies ◽

Nyha Class ◽

Management Strategies ◽

Symptomatic Improvement ◽

Rhythm Control ◽

Ventricular Rate ◽

Ventricular Response

Abstract Background Atrial fibrillation (AF) and flutter (AFL) are common in transthyretin cardiac amyloidosis (ATTR-CM). Ventricular rate control drugs in ATTR-CM are poorly tolerated but data addressing tolerability and efficacy of rhythm control strategies is limited. Purpose We report characteristics and outcomes of AF/AFL in a cohort with ATTR-CM. Methods A single center observational study of patients seen at our Amyloidosis Center with wild-type or hereditary ATTR-CM diagnosed between 2005–2019. Treatment was prescribed as per treating cardiologists. Results Eighty-four patients with ATTR-CM (average age 74±10 years, 94% male) had mean follow-up of 27.6±22.8 months. AF/AFL occurred in 61 patients (73%). Clinically significant rapid ventricular response (RVR) was common as well attempted rate control with AV node blockers (Table 1). However, discontinuation was frequent (80%), often for adverse effects of hypotension (33%), bradycardia (15%), or presyncope/syncope (10%). Rhythm control was initiated in 64%, most often with cardioversion (DCCV) or ablation (Table 2). Post-DCCV recurrence was common (91%) and time to recurrence did not differ with use of anti-arrhythmic drugs (AAD; 5.8 months (IQR 1.9–12.5) vs without AAD 6.2 months (IQR 1.9–12.5) p=0.83). TEE was performed for 33% of DCCV with thrombus seen in 11% of cases – all patients who were not anticoagulated at the time. TEE was otherwise deferred due to known AF/AFL duration <48 hours (13%) or adequate anticoagulation (54%). Ablation was performed in 23% of patients with AFL (all for typical AFL) with 2 patients (14%) having recurrence after mean of 60.9 months. Pulmonary vein isolation for AF was performed in 12% (86% for persistent AF) with 86% recurrence after median of 6.2 months (IQR 5.6–12.3). Most patients (62%) with rhythm control had subjective improvement (≥1 NYHA class or resolved palpitations). Among AAD, amiodarone was most well tolerated with only 8% of patient discontinuing due to side effects. DCCV and ablation resulted in no direct complications although one patient had a perforation of a previously unknown Zenker diverticulum during TEE pre-DCCV. Conclusions In our ATTR-CM cohort, AF/AFL was common. Rate control was poorly tolerated and often abandoned. While rhythm control of AF/AFL had a favorable safety profile and successful conversion to sinus rhythm led to symptomatic improvement in a majority of cases, durable success with rhythm control was limited, often requiring multiple therapies. DCCV is only modestly successful and not significant improved with AAD. Ablation was successful in cases of cavo-tricuspid isthmus dependent AFL but had limited success in AF. FUNDunding Acknowledgement Type of funding sources: None.

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