Effect of atrial fibrillation and an irregular ventricular response on sympathetic nerve activity in human subjects

Stephen L. Wasmund, Jian Ming Li, Richard L. Page, Jose A. Joglar, Robert C. Kowal, Michael L. Smith, Mohamed H. Hamdan

Research output: Contribution to journalArticle

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Abstract

Background - Although the hemodynamic changes associated with atrial fibrillation (AF) have been extensively studied, the neural changes remain unclear. We hypothesized that AF is associated with an increase in sympathetic nerve activity (SNA) and that the irregular ventricular response contributes to this state of sympathoexcitation. Methods and Results - In 8 patients referred for an electrophysiological study, SNA, blood pressure (BP), central venous pressure (CVP), and heart rate were recorded during 3 minutes of normal sinus rhythm (NSR) and 3 minutes of induced AF. In 5 of 8 patients who converted to NSR, right atrial (RA) pacing was performed for 3 minutes in atrial pacing triggered by ventricular sensing mode triggered by playback of an FM tape previously recorded from the right ventricle during AF (RA-irregular) and atrial pacing inhibited by atrial sensing mode at a rate equal to the mean heart rate obtained during AF (RA-regular). SNA data were expressed as percentage of baseline during NSR. SNA increased in all 8 patients during induced AF compared with NSR (171±40% versus 100%, respectively; P<0.01). This was associated with a trend for a decrease in BP and an increase in CVP (P=0.02). Similarly, SNA was significantly higher during RA-irregular pacing compared with RA-regular pacing (124±24% versus 91±20%, respectively; P=0.03), BP and CVP were not significantly different between the 2 pacing modes. Conclusions - Induced AF results in a significant increase in SNA, which is in part attributable to the irregular ventricular response. Our findings suggest that restoring NSR or regularity might be beneficial, particularly in patients with heart failure.

Original languageEnglish (US)
Pages (from-to)2011-2015
Number of pages5
JournalCirculation
Volume107
Issue number15
DOIs
StatePublished - Apr 22 2003

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Human Activities
Atrial Fibrillation
Central Venous Pressure
Blood Pressure
Heart Rate
Heart Ventricles
Heart Failure
Hemodynamics

Keywords

  • Atrium
  • Fibrillation
  • Nervous system

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Effect of atrial fibrillation and an irregular ventricular response on sympathetic nerve activity in human subjects. / Wasmund, Stephen L.; Li, Jian Ming; Page, Richard L.; Joglar, Jose A.; Kowal, Robert C.; Smith, Michael L.; Hamdan, Mohamed H.

In: Circulation, Vol. 107, No. 15, 22.04.2003, p. 2011-2015.

Research output: Contribution to journalArticle

Wasmund, Stephen L. ; Li, Jian Ming ; Page, Richard L. ; Joglar, Jose A. ; Kowal, Robert C. ; Smith, Michael L. ; Hamdan, Mohamed H. / Effect of atrial fibrillation and an irregular ventricular response on sympathetic nerve activity in human subjects. In: Circulation. 2003 ; Vol. 107, No. 15. pp. 2011-2015.
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AU - Hamdan, Mohamed H.

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N2 - Background - Although the hemodynamic changes associated with atrial fibrillation (AF) have been extensively studied, the neural changes remain unclear. We hypothesized that AF is associated with an increase in sympathetic nerve activity (SNA) and that the irregular ventricular response contributes to this state of sympathoexcitation. Methods and Results - In 8 patients referred for an electrophysiological study, SNA, blood pressure (BP), central venous pressure (CVP), and heart rate were recorded during 3 minutes of normal sinus rhythm (NSR) and 3 minutes of induced AF. In 5 of 8 patients who converted to NSR, right atrial (RA) pacing was performed for 3 minutes in atrial pacing triggered by ventricular sensing mode triggered by playback of an FM tape previously recorded from the right ventricle during AF (RA-irregular) and atrial pacing inhibited by atrial sensing mode at a rate equal to the mean heart rate obtained during AF (RA-regular). SNA data were expressed as percentage of baseline during NSR. SNA increased in all 8 patients during induced AF compared with NSR (171±40% versus 100%, respectively; P<0.01). This was associated with a trend for a decrease in BP and an increase in CVP (P=0.02). Similarly, SNA was significantly higher during RA-irregular pacing compared with RA-regular pacing (124±24% versus 91±20%, respectively; P=0.03), BP and CVP were not significantly different between the 2 pacing modes. Conclusions - Induced AF results in a significant increase in SNA, which is in part attributable to the irregular ventricular response. Our findings suggest that restoring NSR or regularity might be beneficial, particularly in patients with heart failure.

AB - Background - Although the hemodynamic changes associated with atrial fibrillation (AF) have been extensively studied, the neural changes remain unclear. We hypothesized that AF is associated with an increase in sympathetic nerve activity (SNA) and that the irregular ventricular response contributes to this state of sympathoexcitation. Methods and Results - In 8 patients referred for an electrophysiological study, SNA, blood pressure (BP), central venous pressure (CVP), and heart rate were recorded during 3 minutes of normal sinus rhythm (NSR) and 3 minutes of induced AF. In 5 of 8 patients who converted to NSR, right atrial (RA) pacing was performed for 3 minutes in atrial pacing triggered by ventricular sensing mode triggered by playback of an FM tape previously recorded from the right ventricle during AF (RA-irregular) and atrial pacing inhibited by atrial sensing mode at a rate equal to the mean heart rate obtained during AF (RA-regular). SNA data were expressed as percentage of baseline during NSR. SNA increased in all 8 patients during induced AF compared with NSR (171±40% versus 100%, respectively; P<0.01). This was associated with a trend for a decrease in BP and an increase in CVP (P=0.02). Similarly, SNA was significantly higher during RA-irregular pacing compared with RA-regular pacing (124±24% versus 91±20%, respectively; P=0.03), BP and CVP were not significantly different between the 2 pacing modes. Conclusions - Induced AF results in a significant increase in SNA, which is in part attributable to the irregular ventricular response. Our findings suggest that restoring NSR or regularity might be beneficial, particularly in patients with heart failure.

KW - Atrium

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