Role of atrial electrophysiology and autonomic nervous system in patients with supraventricular tachycardia and paroxysmal atrial fibrillation.

OBJECTIVES The purposes of this study were to evaluate the atrial electrophysiology and autonomic nervous system in patients who had paroxysmal supraventricular tachycardia (PSVT) associated with paroxysmal atrial fibrillation (PAF). BACKGROUND PAF frequently appeared in patients with PSVT. However, the critical determinants for the occurrence of PAF were not clear. METHODS This study population consisted of 50 patients who had PSVT with (n=23) and without (n=27) PAF. Atrial pressure, atrial size, atrial effective refractory periods (AERPs), and AERP dispersion were evaluated during baseline and PSVT, respectively. Twenty-four hour heart rate variability and baroreflex sensitivity (BRS) were also examined. RESULTS There was greater baseline AERP dispersion in patients with PAF than in those without PAF. The atrial pressure, atrial size, AERPs in the right posterolateral atrium and distal coronary sinus, and AERP dispersion were increased during PSVT as compared with those during baseline. Patients with PAF had greater AERP dispersion than those without PAF during PSVT. The differences of atrial size, right posterolateral AERP, and AERP dispersion between baseline and PSVT were greater in patients with PAF than in those without PAF. BRS, but not heart rate variability, was higher in patients with PAF than in those without PAF. Univariate analysis showed that higher BRS (>4.5 ms/mm Hg, p=0.0002, odds ratio=16.1), AERP dispersion during PSVT (>40 ms, p=0.0008, odds ratio=9.7), and increase of right atrial area during PSVT (>2 cm2, p=0.016, odds ratio=10.7) were significantly correlated with the occurrence of PAF in patients with PSVT. CONCLUSIONS Disturbed atrial electrophysiology and higher vagal reflex could play important roles in the genesis of PAF in patients with PSVT.

[1]  R. Hainsworth.  Reflexes from the heart. , 1991, Physiological reviews.

[2]  M. Allessie,et al.  Pathophysiology of atrial fibrillation: current aspects. , 1993, Herz.

[3]  J M de Bakker,et al.  Increased dispersion of "refractoriness" in patients with idiopathic paroxysmal atrial fibrillation. , 1992, Journal of the American College of Cardiology.

[4]  F. Gaita,et al.  Relation between Spontaneous Atrial Fibrillation and Atrial Vulnerability in Patients with Wolff‐Parkinson‐White Pattern , 1990, Pacing and clinical electrophysiology : PACE.

[5]  M J Lab,et al.  Mechanoelectric feedback in the atrium of the isolated guinea-pig heart. , 1996, Cardiovascular research.

[6]  A. Malliani,et al.  Cardiovascular Neural Regulation Explored in the Frequency Domain , 1991, Circulation.

[7]  R. Sung,et al.  Mechanisms of Spontaneous Alternation between Reciprocating Tachycardia and Atrial Flutter- Fibrillation in the Wolff‐Parkinson‐White Syndrome , 1977, Circulation.

[8]  M. Turiel,et al.  Power Spectral Analysis of Heart Rate and Arterial Pressure Variabilities as a Marker of Sympatho‐Vagal Interaction in Man and Conscious Dog , 1986, Circulation research.

[9]  R. Page,et al.  Incidence of symptomatic atrial fibrillation in patients with paroxysmal supraventricular tachycardia. , 1995, Journal of the American College of Cardiology.

[10]  C. Tai,et al.  Multiple anterograde atrioventricular node pathways in patients with atrioventricular node reentrant tachycardia. , 1996, Journal of the American College of Cardiology.

[11]  E. Prystowsky,et al.  New observations on atrial fibrillation before and after surgical treatment in patients with the Wolff-Parkinson-White syndrome. , 1992, Journal of the American College of Cardiology.

[12]  S Nattel,et al.  Regional and functional factors determining induction and maintenance of atrial fibrillation in dogs. , 1996, The American journal of physiology.

[13]  S Nattel,et al.  Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity. , 1997, The American journal of physiology.

[14]  G. Guiraudon,et al.  Atrial fibrillation in patients with Wolff-Parkinson-White syndrome: incidence after surgical ablation of the accessory pathway. , 1985, Circulation.

[15]  P. S. Chen,et al.  Prevalence of retrograde accessory pathway conduction during atrial fibrillation. , 1996, Journal of cardiovascular electrophysiology.

[16]  W. Rheinboldt,et al.  A COMPUTER MODEL OF ATRIAL FIBRILLATION. , 1964, American heart journal.

[17]  D P Zipes,et al.  Effect of atrioventricular interval during pacing or reciprocating tachycardia on atrial size, pressure, and refractory period. Contraction-excitation feedback in human atrium. , 1990, Circulation.

[18]  J. Brugada,et al.  Atrial fibrillation induced by atrioventricular nodal reentrant tachycardia. , 1997, The American journal of cardiology.

[19]  J A ABILDSKOV,et al.  Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge. , 1959, American heart journal.

[20]  P. Thorén,et al.  Role of cardiac vagal C-fibers in cardiovascular control. , 1979, Reviews of physiology, biochemistry and pharmacology.

[21]  J. Walker,et al.  The effects of acetylcholine in the heart‐lung preparation including the production of auricular fibrillation , 1955, The Journal of physiology.

[22]  C. Chiang,et al.  Accessory pathway and atrioventricular node reentrant tachycardia in elderly patients: clinical features, electrophysiologic characteristics and results of radiofrequency ablation. , 1994, Journal of the American College of Cardiology.

[23]  D. Zipes,et al.  Effects of selective vagal and stellate ganglion stimulation of atrial refractoriness. , 1974, Cardiovascular research.

[24]  D. Zipes,et al.  Unequal Atrial Stretch in dogs Increases Dispersion of Refractoriness Conducive to developing Atrial Fibrillation , 1996, Journal of cardiovascular electrophysiology.

[25]  K. Lee,et al.  Observations on the occurrence of atrial fibrillation in paroxysmal supraventricular tachycardia. , 1986, The American journal of cardiology.

[26]  D. Cameron,et al.  Reflex mechanisms responsible for early spontaneous termination of paroxysmal supraventricular tachycardia. , 1982, The American journal of cardiology.

[27]  J A ABILDSKOV,et al.  Nonuniform distribution of vagal effects on the atrial refractory period. , 1958, The American journal of physiology.

[28]  G. Guiraudon,et al.  Atrial fibrillation inpatients withWolff-Parkinson- Whitesyndrome: incidence after surgical ablation oftheaccessorypathway , 1985 .

[29]  J. Langberg,et al.  Effect of the Atrioventricular Relationship on Atrial Refractoriness in Humans , 1992, Pacing and clinical electrophysiology : PACE.

[30]  G. Klein,et al.  Mode of onset of atrial fibrillation in the Wolff-Parkinson-White syndrome: how important is the accessory pathway? , 1990, Journal of the American College of Cardiology.

[31]  P. Coumel.  Neural aspects of paroxysmal atrial fibrillation , 1992 .

[32]  E. Prystowsky,et al.  Occurrence of Atrial Fibrillation in Patients With Paroxysmal Supraventricular Tachycardia Due to Atrioventricular Nodal Reentry , 1990, Pacing and clinical electrophysiology : PACE.

[33]  J. Jalife,et al.  Cardiac Electrophysiology: From Cell to Bedside , 1990 .

[34]  L Weinert,et al.  Determination of Right Atrial and Right Ventricular Size by Two-Dimensional Echocardiography , 1979, Circulation.

[35]  S Nattel,et al.  Comparative mechanisms of antiarrhythmic drug action in experimental atrial fibrillation. Importance of use-dependent effects on refractoriness. , 1993, Circulation.

[36]  W. Henry,et al.  Relation between Echocardiographically Determined Left Atrial Size and Atrial Fibrillation , 1976, Circulation.

[37]  S. Themistoclakis,et al.  Clinical usefulness of slow pathway ablation in patients with both paroxysmal atrioventricular nodal reentrant tachycardia and atrial fibrillation. , 1997, The American journal of cardiology.