Impact of atrial fibrillation ablation on cardiac sympathetic nervous system in patients with and without heart failure

Masuda, Masaharu; Yamada, Takahisa; Mizuno, Hiroya; Minamiguchi, Hitoshi; Konishi, Shozo; Ohtani, Tomohito; Yamaguchi, Osamu; Okuyama, Yuji; Uematsu, Masaaki; Sakata, Yasushi

doi:10.1016/j.ijcard.2015.07.028

Cited by 20 publications

(10 citation statements)

References 12 publications

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“…Concerning their influence on HR, those antiarrhythmics exert a negative chronotropic effect, somewhat dampening the observed HR increase, and were not used in the control group, where they could have masked a possible HR increase. Fourth, congestive heart failure, hypertension, and chronic kidney disease are accompanied by increased sympathetic activity [ 56 – 58 ]; therefore, the impact of comorbidity cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation

et al. 2018

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BackgroundRecent evidence indicates that sympathetic/parasympathetic coactivation (CoA) is causally linked to changes in heart rate (HR) dynamics. Whether this is relevant for patients with atrial fibrillation (AF) is unknown.Material/MethodsIn patients with paroxysmal AF (n=26) and age-matched controls, (n=10) we investigated basal autonomic outflow and HR dynamics during separate sympathetic (cold hand immersion) and parasympathetic activation (O2-inhalation), as well as during CoA (cold face test). In an additional cohort (n=7), HR response was assessed before and after catheter-based pulmonary vein isolation (PVI). Ultra-high-density endocardial mapping was performed in patients (n=6) before and after CoA.ResultsSympathetic activation increased (control: 74±3 vs. 77±3 bpm, p=0.0098; AF: 60±2 vs. 64±2 bpm, p=0.0076) and parasympathetic activation decreased HR (control: 71±3 vs. 69±3 bpm, p=0.0547; AF: 60±1 vs. 58±2 bpm, p<0.0009), while CoA induced a paradoxical HR increase in patients with AF (control: 73±3 vs. 71±3 bpm, p=0.084; AF: 59±2 vs. 61±2 bpm, p=0.0006), which was abolished after PVI. Non-linear parameters of HR variability (SD1) were impaired during coactivation in patients with AF (control: 61±7 vs. 69±6 ms, p=0.042, AF: 44±32 vs. 32±5 ms, p=0.3929). CoA was associated with a shift of the earliest activation site (18±4 mm) of the sinoatrial nodal region, as documented by ultra-high-density mapping (3442±343 points per map).ConclusionsCoA perturbs HR dynamics and shifts the site of earliest endocardial activation in patients with paroxysmal AF. This effect is abolished by PVI, supporting the value of emerging methods targeting the intrinsic cardiac autonomic nervous system to treat AF. CoA might be a valuable tool to assess cardiac autonomic function in a clinical setting.

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Section: Discussionmentioning

confidence: 99%

Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation

et al. 2018

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“…However, autonomic remodelling involving the posterior left atrium and the pulmonary veins preceded the development of AF in an experimental model of HF . Moreover, in a recent study, ablation for paroxysmal or persistent AF restored sympathetic nervous system status via attenuation of excessive adrenergic tone in HF patients …”

Section: Global Left Atrial Failure In Heart Failurementioning

confidence: 99%

Global left atrial failure in heart failure

Triposkiadis

Pieske

Butler

et al. 2016

European J of Heart Fail

127

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The left atrium plays an important role in the maintenance of cardiovascular and neurohumoral homeostasis in heart failure. However, with progressive left ventricular dysfunction, left atrial (LA) dilation and mechanical failure develop, which frequently culminate in atrial fibrillation. Moreover, LA mechanical failure is accompanied by LA endocrine failure [deficient atrial natriuretic peptide (ANP) processing-synthesis/development of ANP resistance) and LA regulatory failure (dominance of sympathetic nervous system excitatory mechanisms, excessive vasopressin release) contributing to neurohumoral overactivity, vasoconstriction, and volume overload (global LA failure). The purpose of the present review is to describe the characteristics and emphasize the clinical significance of global LA failure in patients with heart failure.

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“…When patients with AF combined with heart failure (HF), a synergistic effect of adrenergic nervous disorders might reduce sympathetic nervous distribution and enhance tone. [20] DC was also reported to had a dose-dependent relationship with HF exacerbation grade in patients with dilated cardiomyopathy. [21] In addition, although one of the most frequent manifestations of diabetic autonomic neuropathy is CANS affecting around 20% of patients with diabetes, [22] but there is no significant difference of complicated with diabetes between the two groups in our study.…”

Section: Discussionmentioning

confidence: 99%

Low deceleration capacity is associated with higher stroke risk in patients with paroxysmal atrial fibrillation

Ding

Liu

et al. 2019

Chinese Medical Journal

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Background:Deceleration capacity (DC) is a non-invasive marker for cardiac autonomic dysfunction; however, few studies have shown that the influence factors of cardiac autonomic dysfunction and the correlations between DC and stroke risk in paroxysmal atrial fibrillation (AF). We aimed to explore the influencing factors of abnormal DC and the relationships between DC and stroke risk in patients with paroxysmal AF.Methods:The study included hospitalized paroxysmal AF patients with DC measurements derived from 24-h Holter electrocardiography recordings taken between August 2015 and June 2016. Multivariable regression analysis was performed to evaluate the associations between correlated variables and abnormal DC values. The relationship between DC and ischemic stroke risk scores in patients with paroxysmal AF was analyzed.Results:We studied 259 hospitalized patients with paroxysmal AF (143 [55.2%] male, mean age 66.4 ± 12.0 years); 38 patients of them showed abnormal DC values. In the univariate analysis, age, hypertension, heart failure, and previous stroke/transient ischemic attack (TIA) were significantly associated with abnormal DC values. Among these factors, a history of previous stroke/TIA (odds ratio = 2.861, 95% confidence interval: 1.356–6.039) were independently associated with abnormal DC values in patients with paroxysmal AF. The abnormal DC group showed a higher stroke risk with the score of congestive heart failure, hypertension, age >75 years, diabetes mellitus, previous stroke and TIA (CHADS2) (2.25 ± 1.48 vs. 1.40 ± 1.34, t = −4.907, P = 0.001) and CHA2DS2-vascular disease, age 65–74 years and female category (VASc) (3.76 ± 1.95 vs. 2.71 ± 1.87, t = −4.847, P = 0.001) scores. Correlation analysis showed that DC was negatively correlated with CHADS2 scores (r = −0.290, P < 0.001) and CHA2DS2-VASc scores (r = −0.263, P < 0.001).Conclusions:Lower DC is closely associated with previous stroke/TIA, and is also correlated negatively with higher stroke risk scores in patients with paroxysmal AF. It could be a potential indicator of stroke risk in paroxysmal AF patients.

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Impact of atrial fibrillation ablation on cardiac sympathetic nervous system in patients with and without heart failure

Cited by 20 publications

References 12 publications

Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation

Sympathetic and Parasympathetic Coactivation Induces Perturbed Heart Rate Dynamics in Patients with Paroxysmal Atrial Fibrillation

Global left atrial failure in heart failure

Low deceleration capacity is associated with higher stroke risk in patients with paroxysmal atrial fibrillation

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