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Am J Physiol Heart Circ Physiol 280: H401-H406, 2001;
0363-6135/01 $5.00
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Vol. 280, Issue 1, H401-H406, January 2001

Diurnal variations of the dominant cycle length of chronic atrial fibrillation

Carl J. Meurling1, Johan E. P. Waktare2, Fredrik Holmqvist1, Antti Hedman3, A. John Camm2, S. Bertil Olsson1, and Marek Malik2

1 Department of Cardiology, Lund University Hospital, Lund, Sweden; 2 Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom; and 3 Department of Medicine, Kuopio University Hospital, Kuopio, Finland

High-resolution digital Holter recording was carried out in 21 patients (15 men, 64 ± 12 yr) with chronic atrial fibrillation. Dominating atrial cycle length (DACL) was derived by frequency domain analysis of QRST-reduced electrocardiograms. Daytime mean DACL was 150 ± 17 ms, and nighttime mean was 157 ± 22 ms (P = 0.0002). Diurnal fluctuation in DACL differed among patients: it tended to be virtually absent in those with a short mean DACL, but in those with longer DACL the night-day difference was as much as 23 ms (R = 0.72, P < 0.001, correlation of mean DACL to night-day difference). Mean DACL also correlated with ventricular cycle length (R = 0.40, P < 0.001), particularly at night (r = 0.49). The shorter cycle lengths found in this study during the day are consistent with sympathetic and/or other physiological modulation, but since increased vagal tone shortens atrial refractoriness in most models, parasympathetic influences are not likely to play a major role. Alternatively, atrial effective refractory period may not be the sole determinant of atrial cycle length during atrial fibrillation.

autonomic nervous system; circadian rhythms


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