Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
University of Copenhagen, Copenhagen, Denmark.
JACC Clin Electrophysiol. 2024 Aug;10(8):1916-1928. doi: 10.1016/j.jacep.2024.05.035. Epub 2024 Jul 31.
Within the broad spectrum of atrial fibrillation (AF) symptomatology, there is a striking subset of patients with predominant or even solitary nocturnal onset of the arrhythmia. This review covers AF with nocturnal onset, with the aim of defining this distinctive subgroup among patients with AF. A periodicity analysis is provided showing a clear increased onset between 10:00 pm and 7:00 am. Multiple interacting mechanisms are discussed, such as circadian modulation of electrophysiological properties, vagal tone, and sleep disorders, as well as the potential interaction and synergism between these factors, to provide a better understanding of this clinical entity. Lastly, potential therapeutic targets for AF with nocturnal onset are addressed such as upstream therapy for underlying comorbidities, type of drug and timing of drug administration and pulmonary vein isolation, ablation of the ganglionated plexus, and autonomic nervous system modulation. Understanding the underlying AF mechanisms in the individual patient with nocturnal onset will contribute to patient-specific therapy.
在心房颤动（AF）症状的广泛谱中，有一组显著的患者，其心律失常主要或甚至仅在夜间发作。这篇综述涵盖了夜间发作的 AF，旨在确定 AF 患者中的这一独特亚组。提供了周期性分析，显示在晚上 10 点到早上 7 点之间明显增加。讨论了多种相互作用的机制，例如电生理特性、迷走神经张力和睡眠障碍的昼夜调节，以及这些因素之间的潜在相互作用和协同作用，以更好地理解这一临床实体。最后，针对夜间发作的 AF 的潜在治疗靶点进行了探讨，例如针对潜在合并症的上游治疗、药物类型和给药时间以及肺静脉隔离、神经节丛消融和自主神经系统调节。了解夜间发作的个体患者中潜在的 AF 机制将有助于针对患者的治疗。
