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Relation of autonomic modulation
to recurrence of atrial fibrillation following
cardioversion.
Kanoupakis
EM, Manios
EG, Mavrakis
HE, Kaleboubas
MD, Parthenakis
FI, Vardas
PE.
Department of Cardiology, Heraklion University
Hospital, Crete, Greece.
The aim of this study was to investigate
the time course of changes in autonomic nervous system activity in
patients with long-standing atrial fibrillation (AF) following internal
electrical conversion to sinus rhythm and to look for differences
between patients who do and do not relapse. Time-domain indexes of heart
rate variability were calculated from 24-hour Holter recordings on the
day of conversion and 1 day and 1 month afterward for 22 patients with
chronic (> 3 months) AF. Ten healthy subjects served as a control
group. During the day of cardioversion the mean RR interval and its
circadian variation differed significantly between controls and
patients. The mean values of successive RR intervals that deviated by
> 50% from the prior RR interval and the root-mean-square of
successive RR interval differences--indexes of vagal modulation--were
initially significantly higher in patients than in controls but showed a
decrease (p < 0.05) by the second day (from 12.4 +/- 7% to 8.1 +/- 5%
to 7.3 +/- 5% and from 49 +/- 9 to 39 +/- 12 to 41 +/- 11 ms,
respectively) to levels similar to those of the controls (7.6 +/- 5% and
40 +/- 17 ms, respectively). Only these 2 indexes contained significant
prognostic information about relapse: patients who later relapsed had
higher initial values than those who did not, and these values remained
high during the 2 days after conversion. In conclusion, this study
provides data confirming that spontaneous chronic AF in humans results
in a significant increase in vagal tone that is reversed with time after
restoration of sinus rhythm. Persistently higher values of vagal tone
are observed in patients who relapse, and are probably a predictor for
recurrence.
Publication Types:
PMID: 11053706 [PubMed - indexed for
MEDLINE]
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