Drs. Lo and Chiou are cofirst authors and have equal contributions to this study.
Differences in the Atrial Electrophysiological Properties Between Vagal and Sympathetic Types of Atrial Fibrillation
Version of Record online: 25 FEB 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 6, pages 609–616, June 2013
How to Cite
LO, L.-W., CHIOU, C.-W., LIN, Y.-J., CHANG, S.-L., HU, Y.-F., TSAO, H.-M., CHAO, T.-F., LI, C.-H., CHANG, H.-Y., CHUNG, F.-P. and CHEN, S.-A. (2013), Differences in the Atrial Electrophysiological Properties Between Vagal and Sympathetic Types of Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 24: 609–616. doi: 10.1111/jce.12098
The present work was supported by the Taipei Veterans General Hospital (V100B-010, V101B-010, V102B-002, V102E7-003), National Scientific Council (NSC100-2314-B-075-054-MY3), and Research Foundation of Cardiovascular Medicine (RFCM 99-01-022, 100-01-004, 100-02-011, 101-01-001).
- Issue online: 4 JUN 2013
- Version of Record online: 25 FEB 2013
- Accepted manuscript online: 22 JAN 2013 04:22AM EST
- Manuscript Accepted: 2 JAN 2013
- Manuscript Revised: 17 DEC 2012
- Manuscript Received: 26 OCT 2012
- Taipei Veterans General Hospital. Grant Numbers: V100B-010, V101B-010, V102B-002, V102E7-003
- National Scientific Council. Grant Number: NSC100-2314-B-075-054-MY3
- Research Foundation of Cardiovascular Medicine. Grant Numbers: RFCM 99-01-022, 100-01-004, 100-02-011, 101-01-001
- atrial fibrillation;
- autonomic nervous system;
- catheter ablation;
- sympathetic AF;
- vagal AF
Substrate Properties Between Vagal and Sympathetic Types of AF
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.
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.
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).
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.