Self-Reported Onset of Paroxysmal Atrial Fibrillation Is Related to Sleeping Body Position

Lisa A Gottlieb, Lorena Sanchez Y Blanco, Mélèze Hocini, Lukas R C Dekker, Ruben Coronel, Lisa A Gottlieb, Lorena Sanchez Y Blanco, Mélèze Hocini, Lukas R C Dekker, Ruben Coronel

Abstract

Background: Because stretch of the atrial myocardium is proarrhythmic for atrial fibrillation (AF) and a left lateral body position increases atrial dimensions in humans, we hypothesized that left lateral recumbence is a frequent AF-triggering body position in AF patients. Methods: We performed a questionnaire study of symptomatic paroxysmal AF (episodes of AF < 1 week) patients scheduled for a first AF ablation therapy at Catharina Hospital, Eindhoven, the Netherlands and at University Hospital, Bordeaux, France. Results: Ninety-four symptomatic paroxysmal AF patients were included [mean age 61 ± 11 years, median AF history of 29(48) months, 31% were females]. Twenty-two percent of patients reported a specific body position as a trigger of their AF symptoms. The triggering body position was left lateral position in 57% of cases, supine position in 33%, right lateral position in 10%, and prone position in 5% (p = 0.003 overall difference in prevalence). Patients with positional AF had a higher body mass index compared to patients without nocturnal/positional AF [28.7(4.2) and 25.4(5.2) kg/m2, respectively, p = 0.025], but otherwise resembled these patients. Conclusion: Body position, and the left lateral position, in particular, is a common trigger of AF in symptomatic AF patients. Moreover, positional AF is associated with overweight. Understanding of the underlying mechanisms of positional AF can contribute to AF treatment and prevention.

Keywords: atrial fibrillation; body mass index; body position; left lateral recumbence; questionnaire.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Gottlieb, Blanco, Hocini, Dekker and Coronel.

Figures

Figure 1
Figure 1
Questionnaire. A 1-page questionnaire was handed out to drug-resistant paroxysmal AF patients admitted to a tertiary center before elective ablation therapy.
Figure 2
Figure 2
The self-reported AF-triggering body position in patients with positional AF. Twenty-one patients reported that taking a specific body position triggered their AF symptoms. The most AF-triggering body position was the left lateral and supine position. A χ2 goodness of fit test demonstrated a statistically significant difference in the prevalence of AF-triggering body positions (p = 0.003). One patient described both the left and right lateral body position as symptom triggering.

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