Published online before print June 23, 2008, doi: 10.1161/CIRCEP.108.784272
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Original Articles |
Atrial Fibrillation Begets Atrial Fibrillation
Autonomic Mechanism for Atrial Electrical Remodeling Induced by Short-Term Rapid Atrial Pacing
From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China (Z. L., H. J.); Cardiac Arrhythmia Research Institute (B.J.S., G.N., M.G., W.M.J., R.L., S.S.P.), Department of Pathology (K.-M. F., L.Z.), the University of Oklahoma Health Sciences Center; and Department of Pathology, Veterans Affair Medical Center, Oklahoma City (K.-M. F.); Zhongshan Hospital, Fudan University, Shanghai, China (J.L.).
Correspondence to Sunny S. Po, MD, PhD, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, Room ET6E103, Oklahoma City, OK 73104. E-mail sunny-po{at}ouhsc.edu
Received April 3, 2008; accepted June 16, 2008.
Background— The mechanism(s) for acute changes in electrophysiological properties of the atria during rapid pacing induced atrial fibrillation (AF) is not completely understood. We sought to evaluate the contribution of the intrinsic cardiac autonomic nervous system in acute atrial electrical remodeling and AF induced by 6-hour rapid atrial pacing.
Methods and Results— Continuous rapid pacing (1200 bpm, 2x threshold [TH]) was performed at the left atrial appendage. Group 1 (n=7) underwent 6-hour pacing immediately followed by ganglionated plexi (GP) ablation; group 2 (n=7) underwent GP ablation immediately followed by 6-hour pacing; and group 3 (n=4) underwent administration of autonomic blockers, atropine (1 mg/kg), and propranolol (0.6 mg/kg) immediately followed by 6-hour pacing. The effective refractory period (ERP) and window of vulnerability (WOV, in milliseconds), ie, the difference between the longest and the shortest coupling interval of the premature stimulus that induced AF, were measured at 2xTH and 10xTH at the left atrium, right atrium, and pulmonary veins every hour before and after GP ablation or autonomic blockade. In group 1, ERP was markedly shortened in the first 2 hours and then stabilized both at 2xTH and 10xTH; however, WOV was progressively widened throughout the 6-hour period. After GP ablation, ERP was significantly longer than before ablation and AF could not be induced (WOV=0) at either 2xTH or 10xTH. In groups 2 and 3, rapid atrial pacing failed to shorten the ERP. AF could not be induced in 6 of 7 dogs in group 2 and all 4 dogs in group 3 during the 6-hour pacing period.
Conclusion— The intrinsic cardiac autonomic nervous system plays a crucial role in the acute stages of atrial electrical remodeling induced by rapid atrial pacing.
Key Words: atrial fibrillation • remodeling • autonomic nerve system
CLINICAL PERSPECTIVE
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/CIRCEP.108. 784272/DCI.
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