Alcohol and Vagal Tone as Triggers for Paroxysmal Atrial Fibrillation
Alcohol and Vagal Tone as Triggers for Paroxysmal Atrial Fibrillation
复制标题
DOI：
10.1016/j.amjcard.2012.03.033
复制
发表时间：
2012-08-01
影响因子：
2.8
通讯作者：
Marcus, Gregory M.
中科院分区：
文献类型：
--
作者：
Mandyam, Mala C.;Vedantham, Vasanth;Marcus, Gregory M.
酒精和迷走神经活动可能是阵发性心房颤动(PAF)的重要触发因素，但由于之前的研究缺乏比较组，这些关联是否比仅凭偶然预期发生的频率更高仍不清楚。我们比较了PAF患者和其他室上性心动过速(SVT)患者自我报告的这些触发事件的频率。在一个大学医学中心连续接受电生理学手术的患者接受了关于心律失常触发因素的结构化访谈。223名有记录的心律失常患者(房颤133例，室上性心动过速90例)完成了调查。多变量调整后，与室上性心动过速患者相比，房颤患者报告饮酒(p=0.014)的几率增加4.42%(95%可信区间1.35~14.44)，报告迷走神经活动(p=0.044)触发心律失常的几率增加2.02(95%可信区间1.02~4.00)。在阵发性房颤患者中，主要饮用啤酒与酒精相关(OR值为4.49，95%CI1.41至14.28，p=0.011)，而年龄较小(OR0.68，95%CI0.49至0.95，p=0.022)和房颤家族史(OR5.73，95%CI1.21至27.23，p=0.028)分别与迷走神经活动引起发作独立相关。有阵发性房颤和酒精触发者更有可能有迷走神经触发者(OR10.32，95%CI1.05~101.42，p=0.045)。总而言之，饮酒和迷走神经活动引起PAF的频率明显高于SVT。酒精和迷走神经触发因素经常出现在相同的PAF患者中，这增加了酒精可能通过迷走神经机制诱发房颤的可能性。(C)2012 Elsevier Inc.保留所有权利。(美国心脏杂志2012；110：364-368)
Alcohol and vagal activity may be important triggers for paroxysmal atrial fibrillation (PAF), but it remains unknown if these associations occur more often than would be expected by chance alone because of the lack of a comparator group in previous studies. We compared self-reported frequency of these triggers in patients with PAF to those with other supraventricular tachycardias (SVTs). Consecutive consenting patients presenting for electrophysiology procedures at a single university medical center underwent a structured interview regarding arrhythmia triggers. Two hundred twenty-three patients with a documented arrhythmia (133 with PAF and 90 with SVT) completed the survey. After multivariable adjustment, patients with PAF had a 4.42 greater odds (95% confidence interval [CI] 1.35 to 14.44) of reporting alcohol consumption (p = 0.014) and a 2.02 greater odds (95% CI 1.02 to 4.00) of reporting vagal activity (p = 0.044) as an arrhythmia trigger compared to patients with SVT. In patients with PAF, drinking primarily beer was associated with alcohol as a trigger (odds ratio [OR] 4.49, 95% CI 1.41 to 14.28, p = 0.011), whereas younger age (OR 0.68, 95% CI 0.49 to 0.95, p = 0.022) and a family history of AF (OR 5.73, 95% CI 1.21 to 27.23, p = 0.028) each were independently associated with having vagal activity provoke an episode. Patients with PAF and alcohol triggers were more likely to have vagal triggers (OR 10.32, 95% CI 1.05 to 101.42, p = 0.045). In conclusion, alcohol consumption and vagal activity elicit PAF significantly more often than SVT. Alcohol and vagal triggers often were found in the same patients with PAF, raising the possibility that alcohol may precipitate AF by vagal mechanisms. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:364-368)