European Heart Journal Advance Access originally published online on February 12, 2008
European Heart Journal 2008 29(5):632-639; doi:10.1093/eurheartj/ehn025
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Autonomic trigger patterns and anti-arrhythmic treatment of paroxysmal atrial fibrillation: data from the Euro Heart Survey
1 Department of Cardiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
2 St George’s University of London, London, UK
3 Hopital Europeen Georges Pompidou, Paris, France
4 Rijnland Ziekenhuis, Leiderdorp, The Netherlands
5 Ospedale Guglielmo da Saliceto, Piacenza, Italy
6 Universitätsklinikum Münster, Münster, Germany
7 Heraklion University Hospital, Heraklion, Greece
8 Martini Hospital Groningen, Groningen, The Netherlands
Received 28 August 2007; revised 15 November 2007; accepted 10 January 2008; online publish-ahead-of-print 12 February 2008.
* Corresponding author. Tel: +31 433875093, Fax: +31 433875104, Email: cdvo{at}cardio.azm.nl
Aims: To investigate the clinical characteristics, management, and outcome of patients with paroxysmal atrial fibrillation (AF) associated with autonomic triggers.
Methods and results: One thousand five hundred and seventeen patients with paroxysmal AF participated in the Euro Heart Survey on AF. We categorized patients according to trigger pattern as reported by the physician: adrenergic (AF associated with exercise, emotion or during daytime only and absence of vagal triggers), vagal (postprandial or night time only, without presence of adrenergic triggers) and mixed (combination of vagal and adrenergic triggers). Vagal AF was found in 91 patients (6%), adrenergic in 229 patients (15%) and mixed in 175 (12%) patients. Underlying heart disease was equally prevalent in the three groups. Among patients with vagal AF, 73% were treated with non-recommended drugs according to the guidelines. In vagal AF, non-recommended treatment was associated with a shift to persistent or permanent AF in 19% of the patients, compared with none in the group receiving recommended treatment (P = 0.06).
Conclusion: This study is the first to address the issue of autonomic trigger patterns and AF in a large population. Autonomic trigger patterns were seen frequently in paroxysmal AF patients. Autonomic influences should be taken into consideration since non-recommended treatment may result in aggravation of vagal AF.
Key Words: Atrial fibrillation • Autonomic nervous system • Guideline adherence • Antiarrhythmia agents • Vagal • Adrenergic