Role of the atrial rate as a factor modulating ventricular response during atrial fibrillation.
BACKGROUND
During atrial fibrillation (AF), RR interval histograms show different populations of predominant RR (pRR) intervals. These pRR intervals have been suggested to be multiples of the refractory period of the atrioventricular (AV) node or caused by the existence of a dual AV node physiology. In this study, the hypothesis that pRR intervals are related to the dominant atrial fibrillatory rate is tested.


METHODS
In this study, Holter electrocardiogram signals from 55 patients with persistent AF were analyzed. Number and position of pRR intervals were detected and compared with mean and standard deviation of the dominant atrial cycle length (DACL). In addition, effects of an enhancement of vagal activity and rate-control treatments (β-blockers and verapamil) were evaluated.


RESULTS
In all patients with more than one pRR interval and in 47% with one pRR interval, RR interval populations were statistically related with multiples of the DACL. During night activities and during β-blockers treatment, mean ventricular rate was decreased (P < 0.01). This change was associated with a variation in the percentage of occurrences of each pRR (P < 0.01), whereas no statistical differences were present in the mean DACL or in the position of pRR intervals. A variation of the DACL due to verapamil was associated with a consistent modification in the position of the pRR intervals.


CONCLUSIONS
The relation between pRR and multiples of the DACL during AF suggests that more probable RR intervals are caused by different conduction ratios of the atrial rate.
Climent
Andreu M
AM
ITACA-BIO, Universidad Politécnica de Valencia, Valencia, Spain. acliment@itaca.upv.es
Guillem
Maria S
MS
Husser
Daniela
D
Castells
Francisco
F
Millet
José
J
Bollmann
Andreas
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000187:drug effects / Q000503:physiopathology*; D014700:Verapamil / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D014700:Verapamil