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(Circulation. 2004;110:e32-e33.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sleep (Vagal)–Induced Atrial Fibrillation

Jagmeet Singh, MD, DPhil; Theofanie Mela, MD; Jeremy Ruskin, MD

From the Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Jagmeet P. Singh, MD, DPhil, GRB 109, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail jsingh{at}partners.org

A 41-year-old man with history of paroxysmal atrial fibrillation underwent routine Holter monitoring for symptoms of palpitations at night. The Holter recording from a person with a regular heart rate is shown in the Figure (A). The Holter recording from our patient (Figure, B) showed initiation of atrial fibrillation with the onset of sleep and spontaneous termination on awakening. This heart rate trend over the 24-hour period illustrates inversion of the normal circadian rhythm, with evidence of a slower heart rate during the daytime hours and a faster heart rate at night. The electrocardiogram below documents the presence of atrial fibrillation during sleep.

View larger version (53K): [in this window] [in a new window]   A, Heart rate trend from a Holter recording showing a normal circadian rhythm with a sleep-induced decrease in heart rate. B, Heart rate trend from a Holter recording in our patient shows an increase in heart rate caused by paroxysmal atrial fibrillation with the onset of sleep and a drop in heart rate after awakening (due to conversion to sinus rhythm). The electrocardiogram documents atrial fibrillation during the sleep period.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Singh, J. Articles by Ruskin, J. Search for Related Content PubMed PubMed Citation Articles by Singh, J. Articles by Ruskin, J. Related Collections Electrophysiology Electrocardiology