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ObjectivesThis study was designed to evaluate autonomic changes preceding atrial fibrillation/flutter (AF) after thoracotomy.BackgroundAutonomic fluctuations before the onset of postoperative AF have been reported but with conflicting results.MethodsIn 48 patients with postoperative AF, 2-h Holter recordings before the onset of AF were compared with corresponding data from 48 age- and gender-matched surgical controls without AF. Five-minute segments of heart rate variability (HRV) were studied using linear regression methods.ResultsThere was a near-significant trend for the RR interval among patients with AF to be lower than controls (p = 0.06), whereas the standard deviation of RRs (p < 0.0001), root mean square of successive RR differences (p < 0.0001), proportion of RRs >50 ms different (p < 0.0001), low-frequency power (p = 0.0003) and its log (p < 0.0001), and high-frequency-power (p < 0.0001) and its log (p < 0.0001) were all significantly greater in patients with AF, respectively. In comparison to controls, AF patients had a significant decrease in RR interval (p = 0.02) and significant increments in all time- and frequency-domain analyses studied.ConclusionsIn the period before the onset of postoperative AF, there are significant increases in HRV during a time when heart rate also increases. These novel findings are consistent with parasympathetic resurgence competing with increasing sympathetic activity as the triggering mechanism for postoperative AF.

Background: The mechanisms of atrial fibrillation/flutter (AF) after major thoracic surgery remain controversial. The goal of the present study was to evaluate autonomic changes preceding postoperative AF. Methods: In 48 patients with postoperative AF 2 h Halter recordings prior to the onset of AF were compared wth corresponding data from 48 ageand gender-matched surgical controls without AF. Five-minute segments of heart rate variability were studied using reoeated measwes ANOVA. Results: There was a near significant trend for the RR-interval among AF patients to be lower than controls IP=O.OE& while the standard deviation of RRs fP