de Vos Cees B, Nieuwlaat Robby, Crijns Harry J G M, Camm A John, LeHeuzey Jean-Yves, Kirchhof Charles J, Capucci Alessandro, Breithardt Günter, Vardas Panos E, Pisters Ron, Tieleman Robert G
Department of Cardiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Eur Heart J. 2008 Mar;29(5):632-9. doi: 10.1093/eurheartj/ehn025. Epub 2008 Feb 12.
To investigate the clinical characteristics, management, and outcome of patients with paroxysmal atrial fibrillation (AF) associated with autonomic triggers.
One thousand five hundred and seventeen patients with paroxysmal AF participated in the Euro Heart Survey on AF. We categorized patients according to trigger pattern as reported by the physician: adrenergic (AF associated with exercise, emotion or during daytime only and absence of vagal triggers), vagal (postprandial or night time only, without presence of adrenergic triggers) and mixed (combination of vagal and adrenergic triggers). Vagal AF was found in 91 patients (6%), adrenergic in 229 patients (15%) and mixed in 175 (12%) patients. Underlying heart disease was equally prevalent in the three groups. Among patients with vagal AF, 73% were treated with non-recommended drugs according to the guidelines. In vagal AF, non-recommended treatment was associated with a shift to persistent or permanent AF in 19% of the patients, compared with none in the group receiving recommended treatment (P = 0.06).
This study is the first to address the issue of autonomic trigger patterns and AF in a large population. Autonomic trigger patterns were seen frequently in paroxysmal AF patients. Autonomic influences should be taken into consideration since non-recommended treatment may result in aggravation of vagal AF.
探讨与自主神经触发因素相关的阵发性心房颤动（房颤）患者的临床特征、治疗及预后。
1517例阵发性房颤患者参与了欧洲房颤调查。我们根据医生报告的触发模式对患者进行分类：肾上腺素能型（房颤与运动、情绪相关或仅在白天发作且无迷走神经触发因素）、迷走神经型（仅在餐后或夜间发作，无肾上腺素能触发因素）和混合型（迷走神经和肾上腺素能触发因素并存）。发现91例患者（6%）为迷走神经型房颤，229例患者（15%）为肾上腺素能型房颤，175例患者（12%）为混合型房颤。三组患者潜在心脏病的患病率相同。在迷走神经型房颤患者中，73%接受了指南不推荐的药物治疗。在迷走神经型房颤患者中，不推荐的治疗使19%的患者转变为持续性或永久性房颤，而接受推荐治疗的患者中无此情况（P = 0.06）。
本研究首次在大量人群中探讨了自主神经触发模式与房颤的问题。自主神经触发模式在阵发性房颤患者中较为常见。由于不推荐的治疗可能导致迷走神经型房颤加重，因此应考虑自主神经的影响。
