Competing autonomic mechanisms precede the onset of postoperative atrial fibrillation.
OBJECTIVE
This study was designed to evaluate autonomic changes preceding atrial fibrillation/flutter (AF) after thoracotomy.


BACKGROUND
Autonomic fluctuations before the onset of postoperative AF have been reported but with conflicting results.


METHODS
In 48 patients with postoperative AF, 2-h Holter recordings before the onset of AF were compared with corresponding data from 48 age- and gender-matched surgical controls without AF. Five-minute segments of heart rate variability (HRV) were studied using linear regression methods.


RESULTS
There was a near-significant trend for the RR interval among patients with AF to be lower than controls (p = 0.06), whereas the standard deviation of RRs (p < 0.0001), root mean square of successive RR differences (p < 0.0001), proportion of RRs >50 ms different (p < 0.0001), low-frequency power (p = 0.0003) and its log (p < 0.0001), and high-frequency-power (p < 0.0001) and its log (p < 0.0001) were all significantly greater in patients with AF, respectively. In comparison to controls, AF patients had a significant decrease in RR interval (p = 0.02) and significant increments in all time- and frequency-domain analyses studied.


CONCLUSIONS
In the period before the onset of postoperative AF, there are significant increases in HRV during a time when heart rate also increases. These novel findings are consistent with parasympathetic resurgence competing with increasing sympathetic activity as the triggering mechanism for postoperative AF.
Amar
David
D
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. amard@mskcc.org
Zhang
Hao
H
Miodownik
Saul
S
Kadish
Alan H
AH
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology*; D001341:Autonomic Nervous System / Q000503:physiopathology*; D016022:Case-Control Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures