The Impact of Pharmacologic Sympathetic and Parasympathetic Blockade on Atrial Electrogram Characteristics in Patients with Atrial Fibrillation.
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...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 34; no. 11; pp. 1460 - 1468 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2011
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104638800&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104638800 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Nov2011 vid: 34 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104638800 67110985 10.1111/j.1540-8159.2011.03212.x NLM21883315 104638800 ppf: 1460 ppct: 8 formats: fmt: @attributes: type: P tig: atl: The Impact of Pharmacologic Sympathetic and Parasympathetic Blockade on Atrial Electrogram Characteristics in Patients with Atrial Fibrillation. aug: au: 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. affil: Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont; Cardiovascular Research Institute, Colchester, Vermont sug: subj: Atrial Fibrillation Physiopathology Sympathetic Nervous System Drug Effects Parasympathetic Nervous System Drug Effects Esmolol Pharmacodynamics Atropine Pharmacodynamics Human Heart Function Tests Methods Descriptive Statistics Heart Atrium Drug Effects Catheter Ablation Methods Middle Age Aged Male Female Wilcoxon Signed Rank Test Mann-Whitney U Test Friedman Test Atrial Fibrillation Surgery Heart Atrium Innervation Funding Source Middle Aged: 45-64 years Aged: 65+ years Male Female ab: 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) pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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