Role of Autonomic Tone in the Initiation and Termination of Paroxysmal Atrial Fibrillation in Patients Without Structural Heart Disease

Tomita, Takeshi; Takei, Manabu; Saikawa, Masahisa; Hanaoka, Takeshi; Uchikawa, Shinichiroh; Tsutsui, Hiroshi; Aruga, Masakazu; Miyashita, Tetsuya; Yazaki, Yoshikazu; Imamura, Hiroshi; Katoh, Osamu; Owa, Mafumi; Kubo, Keishi

doi:10.1046/j.1540-8167.2003.02462.x

Cited by 102 publications

(88 citation statements)

References 25 publications

(35 reference statements)

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“…An underlying increase in central and peripheral chemoresponsiveness may contribute to augmented sympathetic activity and autonomic imbalance, which are predisposing factors for AF (37)(38)(39). It is possible that CSA is a marker of augmented respiratory chemoreflexes and autonomic nervous system dysfunction rather than the primary impetus for AF development.…”

Section: Discussionmentioning

confidence: 99%

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

May

Blackwell

Stone

et al. 2016

Am J Respir Crit Care Med

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Rationale: Although research supports a sleep-disordered breathing and atrial fibrillation association, prospective data examining sleepdisordered breathing predicting incident atrial fibrillation are lacking.Objectives: To investigate sleep-disordered breathing indices as predictors of incident atrial fibrillation.Methods: A cohort (n = 843) of ambulatory older men without prevalent atrial fibrillation was assessed for baseline sleep indices: apnea-hypopnea index, central sleep apnea (central apnea index, >5 vs. ,5), central sleep apnea or Cheyne-Stokes respiration, obstructive apnea-hypopnea index, and percentage of sleep time with less than 90% oxygen saturation. Incident clinically symptomatic adjudicated or self-reported atrial fibrillation outcome was ascertained (mean follow-up, 6.5 6 0.7 yr). We used logistic regression models adjusted for age, race, body mass index, cardiopulmonary disease, alcohol use, pacemaker, cholesterol, cardiac medications, and alternate apnea type for obstructive and central apnea. Age interaction terms and median age-stratified analyses were performed. Conclusions: In older men, central apnea and Cheyne-Stokes respiration predicted increased atrial fibrillation risk, with findings being strongest in older participants in whom overall sleepdisordered breathing also increased atrial fibrillation risk.

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Section: Discussionmentioning

confidence: 99%

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

May

Blackwell

Stone

et al. 2016

Am J Respir Crit Care Med

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“…Fluctuation in autonomic balance is involved in the initiation and termination of PAF [17]. Vagal and sympathetic nerve stimulation results in shortened atrial effective refractory periods and increased dispersion of refractoriness [18,19].…”

Section: Influence Of High Epa/dha Concentrations On L-afmentioning

confidence: 99%

High concentrations of omega-3 fatty acids are associated with the development of atrial fibrillation in the Japanese population

et al. 2012

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“…11 Neurotransmitters released by postganglionic axons of one limb can readily act on nerve terminals of the other, and activation of peripheral components of one elicits activity in the other (reciprocal activation and accentuated antagonism) 11,12 ; it is, thus, difficult to imagine isolated and independent adrenergic or vagal effects in complex arrhythmias, like AF. Supporting evidence for potential clinical implications of these notions comes from several experimental and clinical studies, indicating that a primary increase in adrenergic tone followed by a marked modulation toward vagal predominance precedes episodes of paroxysmal AF, 10,[13][14][15][16] both in patients with lone paroxysmal AF and in those with structural heart disease. 15 This knowledge, mainly formulated by studies conducted during the past decade, is important for potential therapeutic modalities aimed at modulation of the autonomic system: inhibition of the sympathetic limb can be expected (at least in principle) to have an effect not only in the small subset of AF patients with predominantly adrenergic AF but also in the majority of patients with paroxysmal AF.…”

Section: Discussionmentioning

confidence: 98%

Central Sympathetic Inhibition to Reduce Postablation Atrial Fibrillation Recurrences in Hypertensive Patients

et al. 2014

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The objective of this prospective, randomized, controlled study was to test the hypothesis that central sympathetic inhibition, using the centrally acting agent moxonidine, can lead to reduced postablation recurrence risk in patients with hypertension who are undergoing pulmonary vein isolation for drug-refractory paroxysmal AF.Background-The autonomic system is an important determinant of atrial arrhythmogenesis. Current evidence indicates that a combined sympathovagal drive is most commonly responsible for eliciting atrial fibrillation (AF) episodes. The purpose of this study was to test whether moxonidine, a centrally acting sympathoinhibitory agent, can lead to a reduction in postablation AF recurrence. Methods and Results-This was a prospective, double-blinded, randomized study of 291 hypertensive patients with symptomatic paroxysmal AF who were scheduled to undergo pulmonary vein isolation. Patients were randomly assigned to receive either moxonidine (0.2-0.4 mg daily) or placebo, along with standard antihypertensive treatment. No significant differences in blood pressure levels were observed between the 2 groups. In the primary outcome analysis, mean recurrence-free survival was 467 days (95% CI, 445-489 days) in the moxonidine group as compared with 409 days (95% CI, 381-437 days) in control subjects (log rank test, P=0.006). The calculated 12-month recurrence rate estimates were 36.9% in the control group and 20.0% in the moxonidine group (P=0.007). Moxonidine treatment was associated with lower recurrence risk after adjustment for age, body mass index, number of AF episodes in the previous year, and left atrial diameter (adjusted hazard ratio, 0.35 [95% CI, 0.22-0.55]; P<0.001). Conclusions-Treatment with moxonidine is associated with less AF recurrences after ablation treatment for drugrefractory AF in patients with hypertension. The observed effect does not appear to depend on the antihypertensive action of this agent. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01791699.

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Role of Autonomic Tone in the Initiation and Termination of Paroxysmal Atrial Fibrillation in Patients Without Structural Heart Disease

Abstract: This study suggests that the autonomic nervous system plays an important role in both the initiation and termination of PAF. Furthermore, the time of PAF onset influences the autonomic tone at the initiation and termination of PAF.

Cited by 102 publications

References 25 publications

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

High concentrations of omega-3 fatty acids are associated with the development of atrial fibrillation in the Japanese population

Central Sympathetic Inhibition to Reduce Postablation Atrial Fibrillation Recurrences in Hypertensive Patients

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