title: Autonomic trigger patterns and anti-arrhythmic treatment of paroxysmal atrial fibrillation: data from the Euro Heart Survey.
abstract: OBJECTIVE
  To investigate the clinical characteristics, management, and outcome of patients with paroxysmal atrial fibrillation (AF) associated with autonomic triggers.
  
  
  RESULTS
  One thousand five hundred and seventeen patients with paroxysmal AF participated in the Euro Heart Survey on AF. We categorized patients according to trigger pattern as reported by the physician: adrenergic (AF associated with exercise, emotion or during daytime only and absence of vagal triggers), vagal (postprandial or night time only, without presence of adrenergic triggers) and mixed (combination of vagal and adrenergic triggers). Vagal AF was found in 91 patients (6%), adrenergic in 229 patients (15%) and mixed in 175 (12%) patients. Underlying heart disease was equally prevalent in the three groups. Among patients with vagal AF, 73% were treated with non-recommended drugs according to the guidelines. In vagal AF, non-recommended treatment was associated with a shift to persistent or permanent AF in 19% of the patients, compared with none in the group receiving recommended treatment (P = 0.06).
  
  
  CONCLUSIONS
  This study is the first to address the issue of autonomic trigger patterns and AF in a large population. Autonomic trigger patterns were seen frequently in paroxysmal AF patients. Autonomic influences should be taken into consideration since non-recommended treatment may result in aggravation of vagal AF.
authors.affiliation: Department of Cardiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. cdvo@cardio.azm.nl
authors.forename: Cees B
authors.initials: CB
authors.lastname: de Vos
authors.forename: Robby
authors.initials: R
authors.lastname: Nieuwlaat
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: A John
authors.initials: AJ
authors.lastname: Camm
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: LeHeuzey
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Kirchhof
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Panos E
authors.initials: PE
authors.lastname: Vardas
authors.forename: Ron
authors.initials: R
authors.lastname: Pisters
authors.forename: Robert G
authors.initials: RG
authors.lastname: Tieleman
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D001342:Autonomic Nervous System Diseases / Q000150:complications; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D013614:Tachycardia, Paroxysmal / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000889:Anti-Arrhythmia Agents