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European Heart Journal Advance Access originally published online on October 17, 2005
European Heart Journal 2005 26(23):2490-2492; doi:10.1093/eurheartj/ehi598
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Atrial fibrillation and cardiac sympathetic reflexes in heart failure

John S. Floras*

Division of Cardiology, University Health Network and Mount Sinai Hospital, University of Toronto, Suite 1614, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada

* Corresponding author. Tel: +1 416 586 8704; fax: +1 416 586 8702. E-mail address: john.floras@utoronto.ca

This editorial refers to ‘Atrial fibrillation impairs cardiac sympathetic response to baroreceptor unloading in congestive heart failure’{dagger} by P.A. Gould et al., on page 2562

The first 150 words of the full text of this article appear below.

Why do heart failure patients with atrial fibrillation progress more rapidly to pump failure and death than those who remain in sinus rhythm?1 There are many conceivable mechanisms: adverse ventricular remodelling and synchronization; higher filling pressures, yet loss of atrial contraction and lower stroke volume; atrial remodelling; a greater risk of atrial thrombus and embolic stroke; an increased likelihood of central sleep apnoea, which increases the risk of premature death; loss of vagal and sympathetic modulation of heart rate variability; adrenergic augmentation of atrioventricular nodal conduction; adverse effects of rate and rhythm modifying drugs; and altered neural regulation of the heart and circulation by reflexes arising specifically from the atria.

Gould et al.,2 from Melbourne, take up the latter theme, using a radiotracer method Esler developed to quantify the release rate of norepinephrine into plasma. A series of publications from this laboratory has transformed our understanding of the time course, . . . [Full Text of this Article]

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Related articles in EHJ:

Atrial fibrillation impairs cardiac sympathetic response to baroreceptor unloading in congestive heart failure
Paul A. Gould, Michael Yii, Murray D. Esler, John M. Power, and David M. Kaye
EHJ 2005 26: 2562-2567. [Abstract] [Full Text]