Circadian Distribution of Paroxysmal Atrial Fibrillation in Patients with and Without Structural Heart Disease in Untreated State

Overview

Journal Ann Noninvasive Electrocardiol

Specialty Cardiology & Vascular Diseases

Date 2009 Jul 21

PMID 19614641

Citations 6

Authors

Yoshiaki Deguchi

Mari Amino

Kumiko Adachi

Atsushi Matsuzaki

Osamu Iwata

Koichiro Yoshioka

Eiichi Watanabe

Teruhisa Tanabe

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to compare the circadian distribution of the onset, maintenance and termination of paroxysmal atrial fibrillation (PAF) between structural and non-structural heart diseases (SHD and NSHD, respectively) in the untreated state.

Subjects And Methods: We included 217 patients with 338 PAF (79 SHD patients with 131 episodes; 138 NSHD patients with 207 episodes). The probabilities for the onset, maintenance and termination of PAF for each hour were analyzed using Holter monitoring data and harmonic models being fitted into a cosinusoidal function.

Results: The SHD group had a triphasic circadian pattern at the onset with higher peaks at midnight, in the early morning and in the late afternoon (p < 0.05), whereas the NSHD group showed a single peak at midnight (p < 0.01). The probability of maintenance revealed a single peak during midnight (SHD, p < 0.0001; NHD, p < 0.01). The termination showed a peak at noon in the SHD group (p < 0.05), whereas there was a double peak at 10:00 am and 8:00 pm in the NSHD group (p=0.06). RR intervals just after the PAF onset showed marked shortening in the daytime initiation PAF as compared to the nighttime initiation PAF in both SHD and NSHD groups (p < 0.01).

Conclusion: These observations suggest that the SHD group has very complex onset hours, whereas the NSHD group shows complex termination hours. Reflexly accelerated sympathetic tone just after the PAF onset is suggested in the daytime initiation PAF.

Citing Articles

Smartphone and wearable detected atrial arrhythmias in Older Adults: Results of a fully digital European Case finding study.

Fabritz L, Connolly D, Czarnecki E, Dudek D, Guasch E, Haase D Eur Heart J Digit Health. 2023; 3(4):610-625.

PMID: 36710894 PMC: 9779806. DOI: 10.1093/ehjdh/ztac067.

Obstructive sleep apnea and nocturnal attacks of paroxysmal atrial fibrillation.

Lin C, Timofeeva M, OBrien T, Lyons O J Clin Sleep Med. 2021; 18(5):1279-1286.

PMID: 34931608 PMC: 9059602. DOI: 10.5664/jcsm.9840.

Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study.

Okazaki T, Yoshida T, Uchino S, Sasabuchi Y Int J Cardiol Heart Vasc. 2021; 36:100880.

PMID: 34632043 PMC: 8488237. DOI: 10.1016/j.ijcha.2021.100880.

Computed tomography perfusion-based thrombolysis in wake-up stroke.

Morelli N, Rota E, Immovilli P, Cosottini M, Giorgi-Pierfranceschi M, Magnacavallo A Intern Emerg Med. 2015; 10(8):977-84.

PMID: 26370239 DOI: 10.1007/s11739-015-1299-0.

What to do With Wake-Up Stroke.

Rubin M, Barrett K Neurohospitalist. 2015; 5(3):161-72.

PMID: 26288674 PMC: 4530419. DOI: 10.1177/1941874415576204.

References

Kupari M, Koskinen P, Leinonen H . Double-peaking circadian variation in the occurrence of sustained supraventricular tachyarrhythmias. Am Heart J. 1990; 120(6 Pt 1):1364-9. DOI: 10.1016/0002-8703(90)90249-w. View

Rawles J, Metcalfe M, Jennings K . Time of occurrence, duration, and ventricular rate of paroxysmal atrial fibrillation: the effect of digoxin. Br Heart J. 1990; 63(4):225-7. PMC: 1024435. DOI: 10.1136/hrt.63.4.225. View

Wolf P, Abbott R, Kannel W . Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987; 147(9):1561-4. View

Muller J, Ludmer P, Willich S, Tofler G, Aylmer G, Klangos I . Circadian variation in the frequency of sudden cardiac death. Circulation. 1987; 75(1):131-8. DOI: 10.1161/01.cir.75.1.131. View

Clair W, WILKINSON W, McCarthy E, Page R, Pritchett E . Spontaneous occurrence of symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia in untreated patients. Circulation. 1993; 87(4):1114-22. DOI: 10.1161/01.cir.87.4.1114. View

Tsementzis S, Gill J, HITCHCOCK E, Gill S, Beevers D . Diurnal variation of and activity during the onset of stroke. Neurosurgery. 1985; 17(6):901-4. DOI: 10.1227/00006123-198512000-00005. View

Yamashita T, Murakawa Y, Hayami N, Sezaki K, Inoue M, Fukui E . Relation between aging and circadian variation of paroxysmal atrial fibrillation. Am J Cardiol. 1998; 82(11):1364-7. DOI: 10.1016/s0002-9149(98)00642-0. View

Kopecky S, Gersh B, McGoon M, Whisnant J, Holmes Jr D, Ilstrup D . The natural history of lone atrial fibrillation. A population-based study over three decades. N Engl J Med. 1987; 317(11):669-74. DOI: 10.1056/NEJM198709103171104. View

Bingham C, Arbogast B, Guillaume G, Lee J, Halberg F . Inferential statistical methods for estimating and comparing cosinor parameters. Chronobiologia. 1982; 9(4):397-439. View

10.

Willich S, Levy D, Rocco M, Tofler G, Stone P, Muller J . Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol. 1987; 60(10):801-6. DOI: 10.1016/0002-9149(87)91027-7. View

11.

Rocco M, Barry J, Campbell S, Nabel E, Cook E, Goldman L . Circadian variation of transient myocardial ischemia in patients with coronary artery disease. Circulation. 1987; 75(2):395-400. DOI: 10.1161/01.cir.75.2.395. View

12.

Yamashita T, Murakawa Y, Sezaki K, Inoue M, Hayami N, Shuzui Y . Circadian variation of paroxysmal atrial fibrillation. Circulation. 1997; 96(5):1537-41. DOI: 10.1161/01.cir.96.5.1537. View

13.

Kannel W, Abbott R, Savage D, MCNAMARA P . Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982; 306(17):1018-22. DOI: 10.1056/NEJM198204293061703. View

14.

Tanabe T, Yoshikawa H, Tagawa R, Furuya H, Ide M, Goto Y . Evaluation of antiarrhythmic drug efficacy using holter electrocardiographic technique. Jpn Circ J. 1985; 49(3):337-44. DOI: 10.1253/jcj.49.337. View

15.

Feinberg W, Blackshear J, Laupacis A, Kronmal R, Hart R . Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995; 155(5):469-73. View

16.

Muller J, Stone P, Turi Z, Rutherford J, Czeisler C, Parker C . Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med. 1985; 313(21):1315-22. DOI: 10.1056/NEJM198511213132103. View

17.

Hjalmarson A, Gilpin E, NICOD P, DITTRICH H, Henning H, Engler R . Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. Circulation. 1989; 80(2):267-75. DOI: 10.1161/01.cir.80.2.267. View

18.

LOWN B, Tykocinski M, Garfein A, Brooks P . Sleep and ventricular premature beats. Circulation. 1973; 48(4):691-701. DOI: 10.1161/01.cir.48.4.691. View

19.

Mulcahy D, Keegan J, Cunningham D, Quyyumi A, Crean P, Park A . Circadian variation of total ischaemic burden and its alteration with anti-anginal agents. Lancet. 1988; 2(8614):755-9. DOI: 10.1016/s0140-6736(88)92414-2. View

20.

Prinz P, Halter J, Benedetti C, Raskind M . Circadian variation of plasma catecholamines in young and old men: relation to rapid eye movement and slow wave sleep. J Clin Endocrinol Metab. 1979; 49(2):300-4. DOI: 10.1210/jcem-49-2-300. View