Study of ECG-derived atrial fibrillatory rate for prediction of the outcome of cardioversion of short duration atrial fibrillation (CASAF).

AIMS: The present study aimed at testing the hypothesis that atrial fibrillatory rate (AFR) is predictive of sinus rhythm maintenance after electrical cardioversion. METHODS AND RESULTS: The study comprised 32 patients admitted for cardioversion of atrial fibrillation of short duration (mean duration 3.8 ± 7.7 days). AFR was estimated using frequency power spectrum analysis of QRST-cancelled ECG. At six-weeks follow-up 22% of the patients had relapsed to AF. The pre-cardioversion mean AFR of those was 332 ± 64 fpm compared to 378 ± 59 fpm among patients maintaining sinus rhythm (p = 0.12). CONCLUSION: AFR was not predictive of sinus rhythm maintenance in patients of short duration AF undergoing cardioversion. This is in stark contrast with the earlier reported findings. CLINICAL TRIAL REGISTRATION: NCT02112318 (http://www. CLINICALTRIALS: gov).

An atrioventricular node model incorporating autonomic tone.

The response to atrial fibrillation (AF) treatment is differing widely among patients, and a better understanding of the factors that contribute to these differences is needed. One important factor may be differences in the autonomic nervous system (ANS) activity. The atrioventricular (AV) node plays an important role during AF in modulating heart rate. To study the effect of the ANS-induced activity on the AV nodal function in AF, mathematical modelling is a valuable tool. In this study, we present an extended AV node model that incorporates changes in autonomic tone. The extension was guided by a distribution-based sensitivity analysis and incorporates the ANS-induced changes in the refractoriness and conduction delay. Simulated RR series from the extended model driven by atrial impulse series obtained from clinical tilt test data were qualitatively evaluated against clinical RR series in terms of heart rate, RR series variability and RR series irregularity. The changes to the RR series characteristics during head-down tilt were replicated by a 10% decrease in conduction delay, while the changes during head-up tilt were replicated by a 5% decrease in the refractory period and a 10% decrease in the conduction delay. We demonstrate that the model extension is needed to replicate ANS-induced changes during tilt, indicating that the changes in RR series characteristics could not be explained by changes in atrial activity alone.

Autonomic influence on atrial fibrillatory process: head-up and head-down tilting.

BACKGROUND: Changes in the autonomic nervous system (ANS) tone are present before, during, and after episodes of atrial fibrillation (AF). Atrial fibrillatory rate (AFR, the inverse of the atrial cycle length) has been used as a surrogate marker for local refractoriness and is a key characteristic of the fibrillatory process in patients with AF. Aim of this study is to assess changes in AFR, as an effect of autonomic balance change. METHODS: Forty patients undergoing cardiac cardioversion for symptomatic persistent AF were included in the study. Surface ECG was recorded during rest, head-down (HDT, -30°), and head-up tilt (HUT, +60°). A median value of AFR was computed in each phase of the protocol. RESULTS: AFR decreased during HDT compared to the baseline (B) condition in all patients but three (median AFR_B = 391 fpm vs. AFR_HDT = 377 fpm, p < .0001). HUT increased AFR, making it significantly higher than HDT and baseline conditions (median AFR_HUT = 396 fpm, p < .0001 vs. B and HDT). Heart rate (HR) increased during HUT, but had a heterogeneous behavior in the population during HDT: about one third of the patients had an HR lower during HDT than during baseline, whereas the remaining two third had an increase in HR during HDT. CONCLUSIONS: Dominant sympathetic/vagal tone during HUT/HDT significantly affects AFR, increasing/decreasing in respect to baseline. It may be worth exploring the possibility that patients with AF of shorter duration can convert to sinus rhythm during HDT.