In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
Kurzfassung:
Introduction: Abnormal autonomic innervation in the left atrium was reported to be related to developing/sustaining atrial fibrillation (AF). Autonomic denervation by radiofrequency catheter ablation (RFCA), evaluated by heart rate variability (HRV), is associated with a lower recurrence rate of AF. Ganglionated Plexi (GP) has been regarded as a target of autonomic denervation during the RFCA; however, the degree by which autonomic function is altered during the RFCA procedure remains unclear. Hypothesis:We tested the hypothesis that autonomic function is altered consistently during the ablation procedure without targeting GP. Method: Thirteen patients with paroxysmal AF who underwent pulmonary vein isolation (PVI) via RFCA were included (Age, 64.3 ± 1.9; Male/Female, 10/3). PVI was performed in the order prescribed (left superior, left inferior, right superior, and right inferior PV). HRV was assessed prior to, during each PV ablation, and post-ablation. Results: A vagal response (significant bradycardia) during the procedure was observed in three patients. The parameter of para-sympathetic nerve activity (para-SNA) (e.g., RMSSD, 38.7 ± 7.8 vs. 26.6 ± 6.0 ms, P 〈 0.05), and total power of HRV (1861 ± 831 vs. 1105 ± 584 ms, P 〈 0.05) were decreased by the procedure. While the balance of SNA to para-SNA (ratio of low to high frequency, LF/HF) was unchanged, which may indicate both SNA and para-SNA denervation. Using a linear mixed effect model, the effect of the “period” (i.e., pre, each PV, post) on the reduction in para-SNA parameter (HF) or total power of HRV was significant (both, P 〈 0.05). The reduction was consistent in each PV, and post-hoc analysis (Bonferroni) showed significant differences only between baseline and post-RFCA in these parameters (P 〈 0.05). Even in the patients without significant bradycardia response, the reduction in HRV parameter was significant in the linear mixed effect model (e.g., the effect of the “period” on RMSSD, P 〈 0.05). Conclusion: We found that the PVI by RFA, without targeting GP, modified autonomic function, even in the patients who did not develop vagal responses. The HRV change was consistent during each PV isolation, which may suggest the non-necessity of GP ablation for autonomic modification by the ablation.
Materialart:
Online-Ressource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.146.suppl_1.10683
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2022
ZDB Id:
1466401-X
