The baseline characteristics are shown in . Among the SVT group, the primary diagnosis was AVNRT in 50 patients (56%), AVRT in 24 (27%), AVNRT and AVRT in 1 (1%), and atrial tachycardia (AT) in 14 (16%); one individual with SVT had no identifiable SVT mechanism after invasive electrophysiologic testing.
Baseline Characteristics of Patients with Paroxysmal Atrial Fibrillation and Supraventricular Tachycardia
One hundred and ten patients (83%) with PAF and 68 (76%) with SVT answered questions regarding how frequently alcohol consumption provoked their episodes (). Prior to multivariable adjustment, subjects with PAF were more likely to report alcohol as a trigger compared to those with SVT, but this association did not reach statistical significance (). After multivariable adjustment, PAF patients were significantly more likely to report that alcohol provoked their arrhythmia ().
Frequency of Alcohol Consumption as a Trigger for Arrhythmia Episodes in Patients with Paroxysmal Atrial Fibrillation and Supraventricular Tachycardia
Odds Ratios for Triggers of Arrhythmia Episodes in Patients with Paroxysmal Atrial Fibrillation compared to Patients with Supraventricular Tachychardia
In a multivariate ordered logistic regression model including age, gender, race, and all covariates associated with alcohol as a trigger with a p value < 0.1, only drinking primarily beer was independently associated with alcohol as a trigger among those with PAF ().
Figure 1 Multivariate Adjusted Predictors of Alcohol as a Trigger for Arrhythmia Symptoms in Paroxysmal Atrial Fibrillation Patients. *Race was analyzed as white versus non-white in order to satisfy the assumption of proportional odds for this ordered logistic (more ...)
Fifteen of the 28 patients that reported drinking primarily beer also reported drinking primarily wine or spirits. When those 15 were excluded, the analysis regarding drinking primarily beer as a predictor of alcohol triggering PAF was no longer statistically significant. However, when patients reporting more than one type of alcoholic beverage as their primary drink were grouped with either wine or spirits, no significant associations (either unadjusted or adjusted) with alcohol as a trigger were observed.
One hundred and thirty-two (99%) patients with PAF and 89 (99%) with SVT answered questions regarding activities that increased vagal tone. Overall, 111 (50%) reported that vagal activation precipitated their arrhythmia symptoms. Behaviors reported were resting/sleeping (n=105; 95%), eating (n=14; 13%), and symptoms that terminated with exercise (n=17;15%). After multivariable adjustment, PAF patients were significantly more likely to report vagal activation as a trigger compared to those with SVT ().
In a multivariate model designed to identify independent predictors of PAF patients with vagal triggers, both younger age and a family history of AF were significantly associated with having vagal triggers ().
Multivariate Adjusted Predictors of Vagal Activation as a Trigger for Arrhythmia Symptoms in Paroxysmal Atrial Fibrillation Patients. *Race was analyzed as white versus non-white. Error bars denote 95% confidence intervals.
To validate the association with vagal activation, we assessed whether sympathetic activation was more often associated with SVT. Eighty-nine patients reported some sympathetic behavior as a trigger for their arrhythmia symptoms, including exertion in 79 (89%), stress in 16 (18%), and caffeine consumption in 5 (6%). In an unadjusted model, individuals with SVT were more likely to report sympathetic behaviors as a trigger than those with PAF, but this association was no longer significant after multivariable adjustment ().
Among all patients, those who reported that alcohol precipitated their symptoms “often” or “always” were more likely to report vagal activation as a trigger, both prior to (OR 8.82, 95% CI 1.08–72.39, p=0.043) and after multivariable adjustment (OR 13.17, 95% CI 1.37–126.76, p=0.026). In an analysis restricted to PAF patients, the unadjusted point estimate favored an association between alcohol and vagal triggers (OR 7.51, 95% CI 0.89–63.72, p=0.065). After adjusting for age, sex, race, average amount of alcohol consumption, and binge drinking, those who reported alcohol triggered their symptoms “often” or “always” were more likely to describe vagal activation as a trigger for their PAF symptoms (OR 10.32, 95% CI 1.05–101.42, p=0.045). A similar association was not observed when restricting the analysis to those with SVT.
Within the SVT group, there was no significant association between having a particular type of SVT (AVNRT, AVRT, or AT) and reporting alcohol, vagal activation, or sympathetic activation as a trigger for their arrhythmia symptoms, both prior to and after multivariable adjustment.