MECHANISMS AND TREATMENT OF ATRIAL FIBRILLATION
Competing autonomic mechanisms precedethe onset of postoperative atrial fibrillation
David Amar, MD*,*,
Hao Zhang, MD*,
Saul Miodownik, MEE and
Alan H. Kadish, MD
* Departments of Department of Anesthesiology and Critical Care Medicine, New York, New York, USA
Department of Biomedical Engineering, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York, USA
Division of Cardiology, Northwestern University School of Medicine, Chicago, Illinois, USA
Manuscript received September 24, 2002;
revised manuscript received March 25, 2003,
accepted April 3, 2003.
* Reprint requests and correspondence: Dr. David Amar, Professor of Anesthesiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, M-304, New York, New York 10021, USA.
amard{at}mskcc.org
Presented in part at the 52nd Annual Scientific Session of the American College of Cardiology, March 2003, Chicago, Illinois.
OBJECTIVES: This study was designed to evaluate autonomic changes preceding atrial fibrillation/flutter (AF) after thoracotomy.
BACKGROUND: Autonomic fluctuations before the onset of postoperative AF have been reported but with conflicting results.
METHODS: In 48 patients with postoperative AF, 2-h Holter recordings before the onset of AF were compared with corresponding data from 48 age- and gender-matched surgical controls without AF. Five-minute segments of heart rate variability (HRV) were studied using linear regression methods.
RESULTS: There was a near-significant trend for the RR interval among patients with AF to be lower than controls (p = 0.06), whereas the standard deviation of RRs (p < 0.0001), root mean square of successive RR differences (p < 0.0001), proportion of RRs >50 ms different (p < 0.0001), low-frequency power (p = 0.0003) and its log (p < 0.0001), and high-frequency-power (p < 0.0001) and its log (p < 0.0001) were all significantly greater in patients with AF, respectively. In comparison to controls, AF patients had a significant decrease in RR interval (p = 0.02) and significant increments in all time- and frequency-domain analyses studied.
CONCLUSIONS: In the period before the onset of postoperative AF, there are significant increases in HRV during a time when heart rate also increases. These novel findings are consistent with parasympathetic resurgence competing with increasing sympathetic activity as the triggering mechanism for postoperative AF.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation/flutter | | CABG | = coronary artery bypass grafting | | HF | = high-frequency power | | HR | = heart rate | | HRV | = heart rate variability | | LF | = low-frequency power | | pNN50 | = proportion of adjacent RRs >50 ms different | | RMSSD | = root mean square of difference of successive RRs | | SD | = standard deviation |
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