Differences in the atrial electrophysiological properties between vagal and sympathetic types of atrial fibrillation

Li Wei Lo, Chuen Wang Chiou, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Hsuan Ming Tsao, Tze Fan Chao, Cheng Hung Li, Hung Yu Chang, Fa Po Chung, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Substrate Properties Between Vagal and Sympathetic Types of AF Introduction Autonomic modulation of the cardiac activity plays an important role in the pathogenesis of atrial fibrillation (AF). The aim of this study was to assess the differences in the atrial electrical and structural properties between patients with vagal and sympathetic AF. Methods The study included 30 patients (53 ± 12 years old, male 26) with frequent attacks of symptomatic paroxysmal AF. All cases underwent 24-hour ambulatory Holter monitoring before the catheter ablation. The onset of AF accompanied with an increased HF component and decreased L/H ratio was designated as a vagal type (group 1, n = 12), whereas a decreased HF component and increased L/H ratio was classified as a sympathetic type (group 2, n = 18). Electrical and structural properties were evaluated during the ablation procedure. Results All patients had AF originating from PVs. There was a higher incidence of non-PV triggers in group 2 patients than that in group 1 (44% vs 8%, P = 0.04). Group 1 had a higher bipolar peak-to-peak voltage and mean DF of the global left atrium (LA), shorter total activation time, and smaller LA volume than group 2, whereas the electrical and structural properties in the right atrium were similar. After a follow-up of 15 ± 7 months, there was a lower incidence of AF recurrence in group 1 than that in group 2 (0% vs 28%, P = 0.02). Conclusion There are better electrical properties and a smaller LA volume in patients with vagal-type AF. In contrast, the LA substrate is worse, and coexisting non-PV triggers and recurrence following ablation are more prevalent in patients with the sympathetic-type AF.

Original languageEnglish
Pages (from-to)609-616
Number of pages8
JournalJournal of cardiovascular electrophysiology
Volume24
Issue number6
DOIs
StatePublished - Jun 2013

Keywords

  • atrial fibrillation
  • autonomic nervous system
  • catheter ablation
  • sympathetic AF
  • vagal AF

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