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


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.
Wasmund
Stephen L
SL
University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX 75390-9047, USA.
Li
Jian-Ming
JM
Page
Richard L
RL
Joglar
Jose A
JA
Kowal
Robert C
RC
Smith
Michael L
ML
Hamdan
Mohamed H
MH
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology*; D001794:Blood Pressure; D002304:Cardiac Pacing, Artificial; D002496:Central Venous Pressure; D022062:Electrophysiologic Techniques, Cardiac; D006339:Heart Rate; D006352:Heart Ventricles / Q000294:innervation* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010543:Peroneal Nerve / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology*