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Role of the autonomic nervous system in vagal atrial fibrillation
  1. M P van den Berg1,
  2. R J Hassink1,
  3. C Baljé-Volkers2,
  4. H J G M Crijns3
  1. 1Department of Cardiology, Thorax Centre, University Hospital Groningen, Groningen, The Netherlands
  2. 2Trial Coordination Center, University Hospital Groningen
  3. 3Department of Cardiology, University Hospital Maastricht, The Netherlands
  1. Correspondence to:
    Dr MP van den Berg, Department of Cardiology, Thorax Centre, University Hospital Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands;
    m.p.van.den.berg{at}thorax.azg.nl

https://doi.org/10.1136/heart.89.3.333

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    Based on the seminal work of Coumel, the autonomic nervous system is considered to play a pathophysiological role in a subset of patients with atrial fibrillation (AF).1 In particular, Coumel put forward the concept of so-called vagal AF. Yet, the precise role of the autonomic nervous system in vagal AF is unclear. Is vagal AF caused by abnormal autonomic function or abnormal autonomic tone, or is there perhaps an increased sensitivity of the heart to vagal influences? In previous studies,2,3 both autonomic function and autonomic tone were shown to be normal in patients with AF, suggesting that increased sensitivity of the heart to vagal influences plays a role. However, these studies were limited by small sample size. In the present study we sought to collect additional data to define the role of the autonomic nervous system in vagal AF.

    METHODS

    The study group comprised 73 patients with paroxysmal AF. None of the patients had congestive heart failure. On average, patients had a three year history of one paroxysm per week lasting two hours. Patients were considered to have vagal AF if they met the following clinical criteria: (1) most attacks occurred at rest or during sleep, and generally terminated with exercise or in the morning; and (2) if available, typical electrocardiographic findings (preceding sinus bradycardia and a slow ventricular response during AF) were present. Ten patients fulfilled these clinical criteria (vagal AF group); eight men, mean (SD) age 59 (12) years. One patient had hypertension, one patient had mild aortic valve disease, and one patient had angina pectoris, but the other seven patients had lone AF. Mean left …

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