title: Paradoxical change in atrial fibrillation dominant frequencies with baroreflex-mediated parasympathetic stimulation with phenylephrine infusion.
abstract: BACKGROUND
  Parasympathetic stimulation is known to promote atrial fibrillation (AF) through shortening of atrial refractory periods. We hypothesized that baroreflex-mediated parasympathetic stimulation via phenylephrine (PE) infusion would increase AF rate as measured by dominant frequency (DF).
  
  
  RESULTS
  The protocol was performed in 27 patients (24 M, 59 ± 1 years old) prior to AF ablation. For 10 patients in AF, PE was infused until systolic blood pressure increased ≥30 mmHg. Electrograms were recorded in the left atrium before and after PE. DFs of each recording were calculated offline. Atrial effective refractory periods (ERPs) were measured before and after PE in 11 patients who were in sinus rhythm during the procedure. DFs were also measured in 6 patients in AF before and after complete parasympathetic blockade with atropine (0.04 mg/kg). PE resulted in increased RR intervals during sinus rhythm (1,170 ± 77 to 1,282 ± 85 ms, P = 0.03) and AF (743 ± 32 to 826 ± 30 ms, P = 0.03), consistent with parasympathetic effect on the sinus and AV nodes, respectively. DFs were decreased by PE in the left atrium (6.2 ± 0.2 to 6.0 ± 0.2 Hz, P = 0.004). Correspondingly, atrial ERPs significantly increased from 218 ± 13 to 232 ± 11 ms (P = 0.04). Atropine resulted in a decreasing trend in DF in the left atrium (5.9 ± 0.1 to 5.8 ± 0.1 Hz, P = 0.07).
  
  
  CONCLUSIONS
  Despite baroreflex-mediated parasympathetic effect, PE produced a slowing of AF along with lengthening of ERP, while parasympathetic blockade also slowed DF. It is therefore likely that the direct and indirect adrenergic effects of PE on atrial electrophysiology are more prominent than its parasympathetic effects.
authors.affiliation: Division of Cardiology and Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Ng
authors.forename: Rod S
authors.initials: RS
authors.lastname: Passman
authors.forename: Rishi
authors.initials: R
authors.lastname: Arora
authors.forename: Alan H
authors.initials: AH
authors.lastname: Kadish
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
mesh_terms: D000200:Action Potentials; D058646:Adrenergic alpha-1 Receptor Agonists / Q000008:administration & dosage*; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D016279:Atrial Function, Left / Q000187:drug effects*; D001285:Atropine / Q000008:administration & dosage; D017704:Baroreflex / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D010275:Parasympathetic Nervous System / Q000187:drug effects* / Q000503:physiopathology; D010656:Phenylephrine / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D012032:Refractory Period, Electrophysiological; D013997:Time Factors
chemical_list: D058646:Adrenergic alpha-1 Receptor Agonists; D018727:Muscarinic Antagonists; D010656:Phenylephrine; D001285:Atropine