We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
The Impact of Pharmacologic Sympathetic and Parasympathetic Blockade on Atrial Electrogram Characteristics in Patients with Atrial Fibrillation.
- Authors
HABEL, NICOLE; MÜLLER, JOACHIM G.; ZNOJKIEWICZ, PIERRE; THOMPSON, NATHANIEL; CALAME, JAMES; CALAME, SUSAN; NOORI, ARSHIA; GALLO, ANNEMARIE; LUSTGARTEN, DANIEL L.; SOBEL, BURTON E.; SPECTOR, PETER S.
- Abstract
Background: Ablation of atrial autonomic inputs exerts antifibrillatory effects. However, because ablation destroys both myocardium and nerve cells, the effect of autonomic withdrawal alone remains unclear. We therefore examined the effects of pharmacologic autonomic blockade (PAB) on frequency and fractionation in patients with atrial fibrillation (AF). Methods: Esmolol and atropine were administered and electrograms were recorded simultaneously from both atria and the coronary sinus. In 17 patients, AF was recorded for 5 minutes and dominant frequency (DF) and continuous activity (CA) were compared before and during PAB. Results: Examination of the pooled data (537 sites, 17 patients) revealed a statistically significant decrease in mean DF (5.61-5.43Hz, P < 0.001) during PAB. Site-by-site analysis showed that 67% of sites slowed (0.45 ± 0.59 Hz), whereas 32% accelerated (0.49 ± 0.59Hz). Fractionation was reduced: median CA decreased from 31% to 26% (P < 0.001). In patient-by-patient analysis, mean DF/median CA decreased in 13 of 17 patients and increased in four. The spatial heterogeneity of DF decreased in nine of 17 patients (spatial coefficient of variation of DF at 'nondriver sites' decreased by a mean of 2%). Conclusion: PAB decreases DF and CA in the majority of sites. Given the complexity of interactions between atrial cells during AF, the effects of PAB on DF and fractionation are more heterogeneous than the effects of PAB on isolated cells. (PACE 2011; 34:1460-1467)
- Subjects
HEART function tests; CATHETER ablation; ADRENERGIC beta agonists; ANALYSIS of variance; ATRIAL fibrillation; ATROPINE; HEART atrium; PARASYMPATHETIC nervous system; RESEARCH funding; STATISTICS; SYMPATHETIC nervous system; SYMPATHOLYTIC agents; U-statistics; DATA analysis; PHARMACODYNAMICS; INNERVATION
- Publication
Pacing & Clinical Electrophysiology, 2011, Vol 34, Issue 11, p1460
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/j.1540-8159.2011.03212.x