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. 1998 Jul;80(1):71–76. doi: 10.1136/hrt.80.1.71

Autonomic modulation of the atrial cycle length by the head up tilt test: non-invasive evaluation in patients with chronic atrial fibrillation

M Ingemansson 1, M Holm 1, S Olsson 1
PMCID: PMC1728758  PMID: 9764064

Abstract

Objective—To determine the effects of upright posture compared with supine position on the dominant atrial cycle length (DACL) in patients with chronic atrial fibrillation.
Design—The power/frequency spectrum of QRST suppressed lead V1 ECG was studied in 14 patients in the supine position and during the head up tilt table test. The DACL changes were compared with changes in heart rate and blood pressure.
Results—Compared with the supine position, the upright position reduced the DACL from 160 to 150 ms (p < 0.01). The DACL was increased after returning to the supine position from the upright position, from 147 to 154 ms (p < 0.01). Heart rate increased from 91 beats/min in the supine position to 106 in the upright position (p < 0.01). There was a decrease in heart rate from 109 beats/min in the upright position to 93 after returning to the supine position (p < 0.01). No significant changes were seen in systolic or diastolic blood pressure. There were indications of an inverse relation between DACL and heart rate when comparing the supine position before and after tilt with the upright position (p < 0.001).
Conclusions—The sympathetic stimulation and vagal withdrawal induced by rising to upright body position are associated with a decrease in DACL during chronic atrial fibrillation. Thus a reflex increase in sympathetic discharge after induction of atrial fibrillation could favour the persistence of the arrhythmia.

 Keywords: atrial fibrillation;  autonomic nervous system;  atrial cycle length;  heart rate

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Figure 1  .

Figure 1  

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Schematic illustration of the different steps of the FAF-ECG method. (1) Low frequency components were reduced using a linear phase high pass filter. (2) Classification and subtraction of QRST complexes from the original ECG signal. (3) A frequency spectrum was estimated from the residual ECG signal using the fast Fourier transform technique (FFT). (4) The peak frequency of the dominating frequency components between 3 and 12 Hz was estimated, corresponding to the dominant atrial cycle length (DACL).

Figure 2  .

Figure 2  

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Relation of heart rate (HR) and dominant atrial cycle length (DACL) in the patient with syncope, obtained with one minute analysis intervals. The heart rate increased markedly after tilt onset and a rapid decline in both heart rate and DACL was observed before syncope, compatible with strong vagal discharge. The frequency signal had a bimodal appearance with two peaks. Note that the non-dominant peak disappears as the DACL decreases and returns after return to the supine position.

Figure 3  .

Figure 3  

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There were indications of an inverse relation between dominant atrial cycle length (DACL) and heart rate (HR) when the supine position before tilt was compared with the upright position, and when the upright position was compared with the supine position after tilt (correlation coefficient = −0.71, p < 0.001). The relation represents the different effects of increased and decreased sympathetic discharge on the atrial cycle length and AV nodal conduction time, suggesting that the effects of increased sympathetic discharge were superior to the effects of vagal withdrawal on atrial refractoriness.

Figure 4  .

Figure 4  

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A typical patient example, illustrating one minute changes in heart rate (HR) and dominant atrial cycle length (DACL) during the tilt procedure. An increased sympathetic discharge and withdrawal of vagal activity is known to be the physiological response to the head up tilt table test. Increased sympathetic activity during chronic atrial fibrillation may favour the persistence of the arrhythmia and probably reduces the chances for a resumption of sinus rhythm.

Selected References

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