1
|
Maimaitijiang P, Dai Q, Lai Z, Chen A, Zheng L. Prognostic value of cardiac deceleration capacity in patients with atrial fibrillation after catheter ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2024; 35:1007-1016. [PMID: 38468346 DOI: 10.1111/jce.16238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/11/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Cather ablation (CA) is a well-recognized treatment alternative for atrial fibrillation (AF) patients despite more than 20% ablation-treated patients suffering from AF recurrence. The underlying mechanism of AF recurrence postablation is probably associated with high cardiac parasympathetic activity, which can be assessed with deceleration capacity (DC) of heart rate. Given that the relationship between DC and AF recurrence is still controversial, this systematic review and meta-analysis was performed to investigate the characteristics of DC in patients with and without AF recurrence, evaluating the prognostic value of DC in AF patients after CA. METHODS A literature search was systematically performed in the Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases until October 01, 2023. The observational studies reporting either the pre- and postablation DC in both recurrence and non-recurrence groups or the ratios based on DC for predicting AF recurrence were mainly included. Weighted mean differences (WMD) or odds ratios (OR) based on DC would be calculated with a random-effect model, if heterogeneity estimated with the I2 index and Q statistic was significant (I2 > 50% or p < .05); otherwise, a fixed-effect model would be utilized. RESULTS A total of eight observational studies involving 914 AF patients treated with radiofrequency or cryoballoon ablation were included in this study. Ablation-treated patients with AF recurrence had the higher DC postablation in relation to those without recurrence (WMD, 1.00; 95% confidence interval [CI], 0.33-1.67; p < .01), which was present up to 3 months of follow-up (WMD, 1.54; 95% CI, 1.11-1.96; p < .01), whereas there was no statistical significance in DC before ablation between recurrence and non-recurrence groups (WMD, 0.34; 95% CI, -0.12 to 0.79; p = .15). The high DC postablation was a risk factor for AF recurrence in ablation-treated patients (OR, 2.17; 95% CI, 1.44-3.25; p < .01). CONCLUSION The high DC postablation was associated with the risk of AF recurrence, suggesting that DC may act as a prognostic indicator in AF patients treated with CA.
Collapse
Affiliation(s)
- Pakezhati Maimaitijiang
- Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Qi Dai
- Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zihao Lai
- Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aiyue Chen
- Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihui Zheng
- Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
2
|
Zhang E, Liang S, Sun T, Xu J, Lu F, Wu D, Zhang J, He L, Zhang F, Fan S, Ma W. Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1048398. [PMID: 36818913 PMCID: PMC9932203 DOI: 10.3389/fcvm.2022.1048398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Background Atrial fibrillation (AF) has been a worldwide health issue with increasing prevalence and mortality. Recently, increasing attention has been gained to the relationship between heart rate variability (HRV) and the clinical prognosis of AF catheter ablation. We aimed to evaluate the prognostic value of HRV in AF recurrence. Methods We systematically searched Web of Science, PubMed, and Embase from inception until 17 August 2022 to conduct the systematic review and meta-analysis. We included the studies reporting the predictive value of HRV parameters for AF recurrence or in which HRV parameters in AF recurrence and non-recurrence groups were individually reported. Results Finally, we enrolled 16 studies, including 2,352 patients. Higher rMSSD could independently predict AF recurrence following catheter ablation (OR: 1.02, 95% CI: 1.00-1.04; p = 0.03). Higher HF (OR: 1.55, 95% CI: 1.05-2.28; p = 0.03) and lower LF/HF (OR: 1.12, 95% CI: 1.03-1.20; p = 0.004) could independently predict AF recurrence within 1 year. Higher SDNN (OR: 1.02, 95% CI: 101-1.02; p = 0.0006) could independently predict AF recurrence among patients with paroxysmal AF. Almost all HRV parameters within 3 days after catheter ablation and lnHF, lnLF, and rMSSD at 3 months after catheter ablation performed significant differences in AF recurrence and non-recurrence groups. Conclusion Heart rate variability, especially higher rMSSD (within short-term and long-term periods), was closely related to recurrent AF following catheter ablation, highlighting the clinical importance of HRV in the prognosis of AF following catheter ablation.
Collapse
Affiliation(s)
- Enyuan Zhang
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Shuo Liang
- Department of Radiology, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Tianhong Sun
- Cardiac Function Department, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Jing Xu
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China,Jing Xu ✉
| | - Fengmin Lu
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Dongyan Wu
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Jingkun Zhang
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States
| | - Le He
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Fan Zhang
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Shaobo Fan
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Wei Ma
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China,*Correspondence: Wei Ma ✉
| |
Collapse
|
3
|
Hanna P, Buch E, Stavrakis S, Meyer C, Tompkins JD, Ardell JL, Shivkumar K. Neuroscientific therapies for atrial fibrillation. Cardiovasc Res 2021; 117:1732-1745. [PMID: 33989382 PMCID: PMC8208752 DOI: 10.1093/cvr/cvab172] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.
Collapse
Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Eric Buch
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Christian Meyer
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Kirchfeldstraße 40, 40217 Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - John D Tompkins
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Jeffrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| |
Collapse
|
4
|
Tang LYW, Hawkins NM, Ho K, Tam R, Deyell MW, Macle L, Verma A, Khairy P, Sheldon R, Andrade JG. Autonomic Alterations After Pulmonary Vein Isolation in the CIRCA-DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation) Study. J Am Heart Assoc 2021; 10:e018610. [PMID: 33634706 PMCID: PMC8174287 DOI: 10.1161/jaha.120.018610] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The natural history of autonomic alterations following catheter ablation of drug‐refractory paroxysmal atrial fibrillation is poorly defined, largely because of the historical reliance on non‐invasive intermittent rhythm monitoring for outcome ascertainment. Methods and Results The study included 346 patients with drug‐refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using contemporary advanced‐generation ablation technologies. All patients underwent insertion of a Reveal LINQ (Medtronic) implantable cardiac monitor before ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (measured as the SD of the average normal‐to‐normal), daytime heart rate, and nighttime heart rate. Longitudinal autonomic data in the 2‐month period leading up to the date of ablation were compared with the period from 91 to 365 days following ablation. Following ablation there was a significant decrease in SD of the average normal‐to‐normal (mean difference versus baseline of 19.3 ms; range, 12.9–25.7; P<0.0001), and significant increases in daytime and nighttime heart rates (mean difference versus baseline of 9.6 bpm; range, 7.4–11.8; P<0.0001, and 7.4 bpm; range, 5.4–9.3; P<0.0001, respectively). Patients free of arrhythmia recurrence had significantly faster daytime (11±11 versus 8±12 bpm, P=0.001) and nighttime heart rates (8±9 versus 6±8 bpm, P=0.049), but no difference in SD of the average normal‐to‐normal (P=0.09) compared with those with atrial fibrillation recurrence. Ablation technology and cryoablation duration did not influence these autonomic nervous system effects. Conclusions Pulmonary vein isolation results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are correlated with procedural outcome and are independent of the ablation technology used. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01913522.
Collapse
Affiliation(s)
- Lisa Y W Tang
- Data Science Institute University of British Columbia Vancouver Canada
| | - Nathaniel M Hawkins
- Center for Cardiovascular Innovation Vancouver Canada.,Department of Medicine University of British Columbia Vancouver Canada
| | - Kendall Ho
- Data Science Institute University of British Columbia Vancouver Canada.,Department of Emergency Medicine University of British Columbia Vancouver Canada
| | - Roger Tam
- Data Science Institute University of British Columbia Vancouver Canada.,Department of Radiology University of British Columbia Vancouver Canada.,School of Biomedical Engineering University of British Columbia Vancouver Canada
| | - Marc W Deyell
- Center for Cardiovascular Innovation Vancouver Canada.,Department of Medicine University of British Columbia Vancouver Canada
| | - Laurent Macle
- Department of Medicine Montreal Heart InstituteUniversité de Montréal Canada
| | - Atul Verma
- Southlake Regional Health Centre Newmarket Canada
| | - Paul Khairy
- Department of Medicine Montreal Heart InstituteUniversité de Montréal Canada
| | - Robert Sheldon
- Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Jason G Andrade
- Center for Cardiovascular Innovation Vancouver Canada.,Department of Medicine University of British Columbia Vancouver Canada.,Department of Medicine Montreal Heart InstituteUniversité de Montréal Canada
| | | |
Collapse
|
5
|
Styczkiewicz K, Spadacini G, Tritto M, Perego GB, Facchini M, Bilo G, Kawecka-Jaszcz K, Czarnecka D, Malfatto G, Parati G. Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Med (Hagerstown) 2019; 20:297-305. [PMID: 30921268 DOI: 10.2459/jcm.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Ablation procedures for the treatment of atrial fibrillation lead to changes in autonomic heart control; however, there are insufficient data on the possible association of these changes with atrial fibrillation recurrence. The study aim was to assess the effects of pulmonary vein isolation (PVI) on cardiac autonomic modulation and atrial fibrillation recurrence. METHODS We screened 52 patients with atrial fibrillation referred for PVI, of whom 20 patients met inclusion and exclusion criteria, and were enrolled in the study and followed over 6 months. Beat-to-beat blood pressure monitoring was performed 1-2 days before PVI, 1 and 6 months after PVI. We estimated pulse interval variability and spontaneous baroreflex sensitivity (BRS) both in the time and frequency domains, and performed the Valsalva manoeuvre assessing the Valsalva ratio. RESULTS During 6 months after PVI, atrial fibrillation recurrence was observed in six patients. One month after PVI, pulse interval variability and BRS (sequence method) significantly decreased in all patients, returning to preintervention values by 6 months. Patients without atrial fibrillation recurrence at 1 month showed a transient reduction in pulse interval variability (frequency domain) and in BRS (both methods) in contrast to those with atrial fibrillation recurrence. A significant decrease in the Valsalva ratio observed at 1 month was maintained at 6 months after PVI in both groups. CONCLUSION Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.
Collapse
Affiliation(s)
- Katarzyna Styczkiewicz
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Giammario Spadacini
- Electrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)
| | - Massimo Tritto
- Electrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)
| | - Giovanni B Perego
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Mario Facchini
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Grzegorz Bilo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy
| | - Kalina Kawecka-Jaszcz
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Czarnecka
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Gabriella Malfatto
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy
| |
Collapse
|
6
|
Kviesulaitis V, Puodziukynas A, Pauza DH, Zabiela V, Kazakevicius T, Vaitkevicius R, Diržinauskas E, Semaška V, Strazdas A, Unikaite R, Rysevaite K, Pauziene N, Zaliunas R. Heart rate variability after radiofrequency ablation of epicardial ganglionated plexuses on the ovine left atrium. BMC Cardiovasc Disord 2017; 17:292. [PMID: 29233092 PMCID: PMC5727886 DOI: 10.1186/s12872-017-0727-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Ganglionated plexuses (GP) are terminal parts of cardiac autonomous nervous system (ANS). Radiofrequency ablation (RFA) for atrial fibrillation (AF) possibly affects GP. Changes in heart rate variability (HRV) after RFA can reflect ANS modulation. Methods Epicardial RFA of GP on the left atrium (LA) was performed under the general anesthesia in 15 mature Romanov sheep. HRV was used to assess the alterations in autonomic regulation of the heart. A 24 − hour ECG monitoring was performed before the ablation, 2 days after it and at each of the 12 following months. Ablation sites were evaluated histologically. Results There was an instant change in HRV parameters after the ablation. A standard deviation of all intervals between normal QRS (SDNN), a square root of the mean of the squared differences between successive normal QRS intervals (RMSSD) along with HRV triangular index (TI), low frequency (LF) power and high frequency (HF) power decreased, while LF/HF ratio increased. Both the SDNN, LF power and the HF power changes persisted throughout the 12 − month follow − up. Significant decrease in RMSSD persisted only for 3 months, HRV TI for 6 months and increase in LF/HF ratio for 7 months of the follow − up. Afterwards these three parameters were not different from the preprocedural values. Conclusions Epicardial RFA of GP’s on the ovine left atrium has lasting effect on the main HRV parameters (SDNN, HF power and LF power). The normalization of RMSSD, HRV TI and LF/HF suggests that HRV after epicardial RFA of GPs on the left atrium might restore over time.
Collapse
Affiliation(s)
- Vilius Kviesulaitis
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania.
| | - Aras Puodziukynas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | | | - Vytautas Zabiela
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Tomas Kazakevicius
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | | | - Evaldas Diržinauskas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Vytenis Semaška
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Antanas Strazdas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Ruta Unikaite
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Kristina Rysevaite
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Neringa Pauziene
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| |
Collapse
|
7
|
Jungen C, Scherschel K, Eickholt C, Kuklik P, Klatt N, Bork N, Salzbrunn T, Alken F, Angendohr S, Klene C, Mester J, Klöcker N, Veldkamp MW, Schumacher U, Willems S, Nikolaev VO, Meyer C. Disruption of cardiac cholinergic neurons enhances susceptibility to ventricular arrhythmias. Nat Commun 2017; 8:14155. [PMID: 28128201 PMCID: PMC5290156 DOI: 10.1038/ncomms14155] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022] Open
Abstract
The parasympathetic nervous system plays an important role in the pathophysiology of atrial fibrillation. Catheter ablation, a minimally invasive procedure deactivating abnormal firing cardiac tissue, is increasingly becoming the therapy of choice for atrial fibrillation. This is inevitably associated with the obliteration of cardiac cholinergic neurons. However, the impact on ventricular electrophysiology is unclear. Here we show that cardiac cholinergic neurons modulate ventricular electrophysiology. Mechanical disruption or pharmacological blockade of parasympathetic innervation shortens ventricular refractory periods, increases the incidence of ventricular arrhythmia and decreases ventricular cAMP levels in murine hearts. Immunohistochemistry confirmed ventricular cholinergic innervation, revealing parasympathetic fibres running from the atria to the ventricles parallel to sympathetic fibres. In humans, catheter ablation of atrial fibrillation, which is accompanied by accidental parasympathetic and concomitant sympathetic denervation, raises the burden of premature ventricular complexes. In summary, our results demonstrate an influence of cardiac cholinergic neurons on the regulation of ventricular function and arrhythmogenesis. Catheter ablation is a common therapy for atrial fibrillation but disrupts cardiac cholinergic neurons. Here the authors report that cholinergic neurons innervate heart ventricles and show that their ablation leads to increased susceptibility to ventricular arrhythmias in mouse models and in patients.
Collapse
Affiliation(s)
- Christiane Jungen
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Katharina Scherschel
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Nadja Bork
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Tim Salzbrunn
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Fares Alken
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stephan Angendohr
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christiane Klene
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Janos Mester
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Nikolaj Klöcker
- Institute of Neural and Sensory Physiology, Medical Faculty, University of Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Marieke W Veldkamp
- Academic Medical Center, University of Amsterdam, Department of Clinical and Experimental Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Viacheslav O Nikolaev
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, cardiac Neuro- and Electrophysiology Research Group (cNEP), University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| |
Collapse
|
8
|
Proietti R, Santangeli P, Di Biase L, Joza J, Bernier ML, Wang Y, Sagone A, Viecca M, Essebag V, Natale A. Comparative Effectiveness of Wide Antral Versus Ostial Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2014; 7:39-45. [DOI: 10.1161/circep.113.000922] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
For the past decade, electric pulmonary vein isolation (PVI) has become a procedure implemented worldwide for the treatment of atrial fibrillation. Currently, 2 main approaches are used for PVI: ostial isolation of the PVs and wide antral PVI. The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications.
Methods and Results—
Studies were identified by searching electronic databases for studies on ostial versus antral PVI. Information was extracted from each included trial. Odds ratio was the primary measure of treatment effect or side effects. The proportion of patients with recurrences of atrial fibrillation or other atrial tachyarrhythmias was evaluated at the end of the follow-up periods in 12 trials, including 1183 patients. The recurrence rate of total supraventricular arrhythmias was significantly lower in wide antral than in segmental PVI group (odds ratio, 0.42; 95% confidence interval, 0.32–0.56;
P
<0.00001). Atrial fibrillation recurrence was significantly lower in the wide antral group (odds ratio, 0.33; 95% confidence interval, 0.24–0.46;
P
<0,00001). A trend toward a higher incidence of left atrial tachycardia occurrence in the wide antral circumferential ablation group was detected, which did not reach statistical significance (odds ratio, 1.53; 95% confidence interval, 0.88–2.69;
P
=0.13).
Conclusions—
Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up.
Collapse
Affiliation(s)
- Riccardo Proietti
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Pasquale Santangeli
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Luigi Di Biase
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Jacqueline Joza
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Martin Louis Bernier
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Yang Wang
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Antonio Sagone
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Maurizio Viecca
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Vidal Essebag
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| | - Andrea Natale
- From the Cardiology Department, Luigi Sacco Hospital, Milan, Italy (R.P., A.S., M.V.); Cardiac Electrophysiology Service, McGill University Health Center, Montreal, Canada (R.P., J.J., M.L.B., V.E.); Department of Cardiology, University of Pennsylvania, Philadelphia (P.S.); Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Hôpital Sacre Cœur de Montréal, Montréal, Canada (V.E.); Texas Cardiac
| |
Collapse
|
9
|
Denervation as a common mechanism underlying different pulmonary vein isolation strategies for paroxysmal atrial fibrillation: evidenced by heart rate variability after ablation. ScientificWorldJournal 2013; 2013:569564. [PMID: 24058286 PMCID: PMC3766572 DOI: 10.1155/2013/569564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/19/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDS Segmental and circumferential pulmonary vein isolations (SPVI and CPVI) have been demonstrated to be effective therapies for paroxysmal atrial fibrillation (PAF). PVI is well established as the endpoint of different ablation techniques, whereas it may not completely account for the long-term success. METHODS 181 drug-refractory symptomatic PAF patients were referred for segmental or circumferential PVI (SPVI = 67; CPVI = 114). Heart rate variability (HRV) was assessed before and after the final ablation. RESULTS After following up for 62.23 ± 12.75 months, patients underwent 1.41 ± 0.68 procedures in average, and the success rates in SPVI and CPVI groups were comparable. 119 patients were free from AF recurrence (SPVI-S, n = 43; CPVI-S, n = 76). 56 patients had recurrent episodes (SPVI-R, n = 21; CPVI-R, n = 35). Either ablation technique decreased HRV significantly. Postablation SDNN and rMSSD were significantly lower in SPVI-S and CPVI-S subgroups than in SPVI-R and CPVI-R subgroups (SPVI-S versus SPVI-R: SDNN 91.8 ± 32.6 versus 111.5 ± 36.2 ms, rMSSD 47.4 ± 32.3 versus 55.2 ± 35.2 ms; CPVI-S versus CPVI-R: SDNN 83.0 ± 35.6 versus 101.0 ± 40.7 ms, rMSSD 41.1 ± 22.9 versus 59.2 ± 44.8 ms; all P < 0.05). Attenuation of SDNN and rMSSD remained for 12 months in SPVI-S and CPVI-S subgroups, whereas it recovered earlier in SPVI-R and CPVI-R subgroups. Multivariate logistic regression analysis identified SDNN as the only predictor of long-term success. CONCLUSIONS Beyond PVI, denervation may be a common mechanism underlying different ablation strategies for PAF.
Collapse
|
10
|
Zhuang J, Wang Y, Tang K, Li X, Peng W, Liang C, Xu Y. Association between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation: a systematic review and meta-analysis of observational studies. Europace 2011; 14:638-45. [PMID: 22117033 DOI: 10.1093/europace/eur364] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jianhui Zhuang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | | | | | | | | | | | | |
Collapse
|