Clinical investigationCircadian variation of arrhythmia onset patterns in patients with persistent atrial fibrillation
Section snippets
Patients
Fifteen consecutive patients (mean age 63 ± 14 years, 80% male) implanted with the Medtronic (Minneapolis, Minn) Jewel AF atrial defibrillator (model 7250) were studied. All patients gave written informed consent approved by the local Research Ethical Committee. Patient demographics, underlying etiology, and antiarrhythmic drug use are shown in Table I. None of the patients had a preimplant history of paroxysmal episodes. A minimum of 2 preimplant ambulatory 24-hour tapes were obtained and a
Results
Patients were followed-up for a mean of 23 ± 7 months. There were 227 episodes of persistent AT treated by patient-activated defibrillation (median 9 per patient). Table I shows the number of arrhythmia episodes for each patient. The onset time distribution during the 24-hour period was nonuniform (P < .0001) with a single harmonic circadian pattern peaking at midnight (Figure 2). Seventy-four percent of persistent episodes initiated between 8 pm and 8 am. The median duration of persistent AT
Discussion
It is well recognized that a large number of cardiac conditions exhibit a circadian pattern. Myocardial infarction has a peak incidence between 6 am and midday, sudden cardiac death and malignant ventricular arrhythmias are more common in the morning, and there are circadian patterns for supraventricular arrhythmias and stroke.1, 2, 3, 12, 13, 14 There are also diurnal variations in a number of electrophysiological parameters such as heart rate, QT interval, sinus node recovery time, atrial
Acknowledgements
We are extremely grateful for the statistical assistance and advice provided by Dr Derek Robinson from the University of Sussex, Brighton, UK.
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