title: Differences in the atrial electrophysiological properties between vagal and sympathetic types of atrial fibrillation.
abstract: BACKGROUND
  Autonomic modulation of the cardiac activity plays an important role in the pathogenesis of atrial fibrillation (AF). The aim of this study was to assess the differences in the atrial electrical and structural properties between patients with vagal and sympathetic AF.
  
  
  METHODS
  The study included 30 patients (53 ± 12 years old, male 26) with frequent attacks of symptomatic paroxysmal AF. All cases underwent 24-hour ambulatory Holter monitoring before the catheter ablation. The onset of AF accompanied with an increased HF component and decreased L/H ratio was designated as a vagal type (group 1, n = 12), whereas a decreased HF component and increased L/H ratio was classified as a sympathetic type (group 2, n = 18). Electrical and structural properties were evaluated during the ablation procedure.
  
  
  RESULTS
  All patients had AF originating from PVs. There was a higher incidence of non-PV triggers in group 2 patients than that in group 1 (44% vs 8%, P = 0.04). Group 1 had a higher bipolar peak-to-peak voltage and mean DF of the global left atrium (LA), shorter total activation time, and smaller LA volume than group 2, whereas the electrical and structural properties in the right atrium were similar. After a follow-up of 15 ± 7 months, there was a lower incidence of AF recurrence in group 1 than that in group 2 (0% vs 28%, P = 0.02).
  
  
  CONCLUSIONS
  There are better electrical properties and a smaller LA volume in patients with vagal-type AF. In contrast, the LA substrate is worse, and coexisting non-PV triggers and recurrence following ablation are more prevalent in patients with the sympathetic-type AF.
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Li-Wei
authors: LW
authors: Lo
authors: Chuen-Wang
authors: CW
authors: Chiou
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Shih-Lin
authors: SL
authors: Chang
authors: Yu-Feng
authors: YF
authors: Hu
authors: Hsuan-Ming
authors: HM
authors: Tsao
authors: Tze-Fan
authors: TF
authors: Chao
authors: Cheng-Hung
authors: CH
authors: Li
authors: Hung-Yu
authors: HY
authors: Chang
authors: Fa-Po
authors: FP
authors: Chung
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology*; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014630:Vagus Nerve / Q000503:physiopathology*