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. 2009 Jul;14(3):280-9.
doi: 10.1111/j.1542-474X.2009.00311.x.

Circadian distribution of paroxysmal atrial fibrillation in patients with and without structural heart disease in untreated state

Yoshiaki Deguchi  1 , Mari Amino, Kumiko Adachi, Atsushi Matsuzaki, Osamu Iwata, Koichiro Yoshioka, Eiichi Watanabe, Teruhisa Tanabe
Affiliations

Circadian distribution of paroxysmal atrial fibrillation in patients with and without structural heart disease in untreated state

Yoshiaki Deguchi et al. Ann Noninvasive Electrocardiol. 2009 Jul.

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.

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Figures

Figure 1
Figure 1
Age distribution of paroxysmal atrial fibrillation (PAF) in patients with structural and nonstructural heart diseases (NHD and NSHD, respectively).
Figure 2
Figure 2
Distribution of the episode duration of PAF—its comparison between patients with SHD and NSHD, respectively.
Figure 3
Figure 3
Hourly total duration of PAF in SHD and NSHD, respectively. Very similar single harmonic fit of the data with a peak (longest duration) around 3:00–4:00 AM and with a nadir (shortest duration) around 4:00–5:00 PM in PAF is observed in both groups.
Figure 4
Figure 4
(A) Hourly probabilities of the onset of PAF in patients with SHD and NSHD, respectively. A marked difference in the circadian distribution is documented between the two groups. The details are described in the text. (B) Hourly probabilities of maintenance of PAF in patients with SHD and NSHD, respectively. The circadian distribution reveals a single harmonic fitting in both groups. The details are described in the text. (C) Hourly probabilities of termination of PAF in patients with SHD and NSHD, respectively. The distribution is in a mirror image of the distribution of maintenance in the SHD group, whereas it shows a double harmonic curve without a mirror image in the NSHD group. The details are described in the text.
Figure 4
Figure 4
(A) Hourly probabilities of the onset of PAF in patients with SHD and NSHD, respectively. A marked difference in the circadian distribution is documented between the two groups. The details are described in the text. (B) Hourly probabilities of maintenance of PAF in patients with SHD and NSHD, respectively. The circadian distribution reveals a single harmonic fitting in both groups. The details are described in the text. (C) Hourly probabilities of termination of PAF in patients with SHD and NSHD, respectively. The distribution is in a mirror image of the distribution of maintenance in the SHD group, whereas it shows a double harmonic curve without a mirror image in the NSHD group. The details are described in the text.
Figure 4
Figure 4
(A) Hourly probabilities of the onset of PAF in patients with SHD and NSHD, respectively. A marked difference in the circadian distribution is documented between the two groups. The details are described in the text. (B) Hourly probabilities of maintenance of PAF in patients with SHD and NSHD, respectively. The circadian distribution reveals a single harmonic fitting in both groups. The details are described in the text. (C) Hourly probabilities of termination of PAF in patients with SHD and NSHD, respectively. The distribution is in a mirror image of the distribution of maintenance in the SHD group, whereas it shows a double harmonic curve without a mirror image in the NSHD group. The details are described in the text.
Figure 5
Figure 5
(A) Average RR intervals for 5 beats just after the onset and just before the termination of PAF in the daytime and nighttime initiation PAF. Details are described in the text. (B) Minimum RR intervals for 5 beats just after the onset and just before the termination of PAF in the daytime and nighttime initiation PAF. Details are described in the text.
Figure 5
Figure 5
(A) Average RR intervals for 5 beats just after the onset and just before the termination of PAF in the daytime and nighttime initiation PAF. Details are described in the text. (B) Minimum RR intervals for 5 beats just after the onset and just before the termination of PAF in the daytime and nighttime initiation PAF. Details are described in the text.
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