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Zuhair M, Keene D, Kanagaratnam P, Lim PB. Percutaneous Neuromodulation for Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:281-296. [PMID: 39084721 DOI: 10.1016/j.ccep.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.
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Affiliation(s)
- Mohamed Zuhair
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK.
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
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2
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Honarbakhsh S, Roney C, Horrach CV, Lambiase PD, Hunter RJ. Autonomic modulation impacts conduction velocity dynamics and wavefront propagation in the left atrium. Europace 2024; 26:euae219. [PMID: 39230049 PMCID: PMC11372476 DOI: 10.1093/europace/euae219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/12/2024] [Indexed: 09/05/2024] Open
Abstract
AIMS Atrial fibrosis and autonomic remodelling are proposed pathophysiological mechanisms in atrial fibrillation (AF). Their impact on conduction velocity (CV) dynamics and wavefront propagation was evaluated. METHODS AND RESULTS Local activation times (LATs), voltage, and geometry data were obtained from patients undergoing ablation for persistent AF. LATs were obtained at three pacing intervals (PIs) in sinus rhythm (SR). LATs were used to determine CV dynamics and their relationship to local voltage amplitude. The impact of autonomic modulation- pharmacologically and with ganglionated plexi (GP) stimulation, on CV dynamics, wavefront propagation, and pivot points (change in wavefront propagation of ≥90°) was determined in SR. Fifty-four patients were included. Voltage impacted CV dynamics whereby at non-low voltage zones (LVZs) (≥0.5 mV) the CV restitution curves are steeper [0.03 ± 0.03 m/s ΔCV PI 600-400 ms (PI1), 0.54 ± 0.09 m/s ΔCV PI 400-250 ms (PI2)], broader at LVZ (0.2-0.49 mV) (0.17 ± 0.09 m/s ΔCV PI1, 0.25 ± 0.11 m/s ΔCV PI2), and flat at very LVZ (<0.2 mV) (0.03 ± 0.01 m/s ΔCV PI1, 0.04 ± 0.02 m/s ΔCV PI2). Atropine did not change CV dynamics, while isoprenaline and GP stimulation resulted in greater CV slowing with rate. Isoprenaline (2.7 ± 1.1 increase/patient) and GP stimulation (2.8 ± 1.3 increase/patient) promoted CV heterogeneity, i.e. rate-dependent CV (RDCV) slowing sites. Most pivot points co-located to RDCV slowing sites (80.2%). Isoprenaline (1.3 ± 1.1 pivot increase/patient) and GP stimulation (1.5 ± 1.1 increase/patient) also enhanced the number of pivot points identified. CONCLUSION Atrial CV dynamics is affected by fibrosis burden and influenced by autonomic modulation which enhances CV heterogeneity and distribution of pivot points. This study provides further insight into the impact of autonomic remodelling in AF.
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Affiliation(s)
- Shohreh Honarbakhsh
- Queen Mary University of London, London, UK
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | | | | | - Pier D Lambiase
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Ross J Hunter
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
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3
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Hori Y, Aoki H, Nakahara S. Editorial to "Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures". J Arrhythm 2024; 40:1016-1017. [PMID: 39139878 PMCID: PMC11317649 DOI: 10.1002/joa3.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Yuichi Hori
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
| | - Hideyuki Aoki
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
| | - Shiro Nakahara
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
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4
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Karatela MF, Fudim M, Mathew JP, Piccini JP. Neuromodulation therapy for atrial fibrillation. Heart Rhythm 2023; 20:100-111. [PMID: 35988908 DOI: 10.1016/j.hrthm.2022.08.011] [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: 05/17/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023]
Abstract
Atrial fibrillation has a multifactorial pathophysiology influenced by cardiac autonomic innervation. Both sympathetic and parasympathetic influences are profibrillatory. Innovative therapies targeting the neurocardiac axis include catheter ablation or pharmacologic suppression of ganglionated plexi, renal sympathetic denervation, low-level vagal stimulation, and stellate ganglion blockade. To date, these therapies have variable efficacy. As our understanding of atrial fibrillation and the cardiac nervous system expands, our approach to therapeutic neuromodulation will continue evolving for the benefit of those with AF.
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Affiliation(s)
- Maham F Karatela
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Jonathan P Piccini
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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5
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Sakai J, Takami M, Fukuzawa K, Kiuchi K, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Nakasone K, Yamamoto K, Suzuki Y, Tani K, Iwai H, Nakanishi Y, Hirata KI. Sex Differences in the Regional Analysis of Nonpulmonary Vein Foci and Epicardial Adipose Tissue in Patients With Atrial Fibrillation. Circ J 2022; 87:29-40. [PMID: 35989301 DOI: 10.1253/circj.cj-22-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The mechanism underlying the sex differences in atrial fibrillation (AF) recurrence following pulmonary vein (PV) isolation is not fully understood. We hypothesized that non-PV foci and epicardial adipose tissue (EAT) play a key role. METHODS AND RESULTS Data from 304 consecutive patients (75% males) who underwent contrast-enhanced computed tomography and catheter ablation of AF were reviewed. The EAT around the atrium was measured separately in 4 parts of the atrium. All patients underwent high-dose isoproterenol infusions to assess the non-PV foci. Significantly more non-PV foci and less EAT around the atrium were observed in female patients than in male patients. In males, those with non-PV foci on the left atrial (LA) anterior wall had significantly greater EAT for the same lesions than those without non-PV foci. During a median follow-up of 27 months, the predictors of AF recurrence after first catheter ablation were female sex, presence of non-PV foci, LA diameter, and septal EAT index. A sex-specific analysis revealed that LA diameter was a predictor only in males and that the presence of non-PV foci in the septal region was a strong predictor in males (hazard ratio [HR]: 2.24) and females (HR: 3.65). CONCLUSIONS Sex-specific differences were observed in non-PV foci sites and local EAT and in regard to the predictors of AF recurrence.
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Affiliation(s)
- Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Mitsuru Takami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yusuke Sonoda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Takahara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yuya Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kenichi Tani
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidehiro Iwai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yusuke Nakanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Xie X, Chen Z, Luo Y, Li X, Zhou J, Yu J, Yang B. Severe coronary artery spasm during left atrial appendage closure plus catheter ablation for atrial fibrillation: case presentation. BMC Cardiovasc Disord 2022; 22:38. [PMID: 35148671 PMCID: PMC8832689 DOI: 10.1186/s12872-022-02483-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Left atrial appendage closure (LAAC) combined with radiofrequency catheter ablation (RFCA) as a hybrid procedure is commonly performed to treat atrial fibrillation (AF). Although this treatment carries a low risk of coronary artery spasm (CAS), and has never been observed in LAAC procedure, caution still needed to be taken. We presented a case of CAS that occurred in an AF patient during the hybrid procedure. Case presentation The patient was a 65-year-old man with paroxysmal AF who developed CAS during RFCA and LAAC. In this case, LAAC was performed ahead of RFCA. After atrial septal puncture, the occluder was advanced into left atrium through delivery sheath, and successfully deployed in the LAA. After verifying the assessment of “PASS” criteria, we decided to release the device. However, before releasing the occluder in LAAC, the patient’s blood pressure (BP) fell to 70/45 mmHg with heart rate (HR) drop and ST-segment elevation in II, III, and aVF and reciprocal ST-segment depression in I and aVL. Isotonic sodium chloride load was administered. After 3 min, the BP and HR raised, and ST-segment returned to normal. The occluder was successfully released after the stable condition of the patient. Then, RFCA was sequentially performed. When isolating the right pulmonary veins, the patient’s BP and HR fell again with ST-segment elevation in inferior leads. Spontaneous ventricular tachycardia and fibrillation developed rapidly and defibrillation was performed immediately with success. Coronary angiography revealed the obstruction of the right coronary artery which disappeared completely after intracoronary nitroglycerin injection (1 mg). Under systemic diltiazem infusion, the RFCA procedure was accomplished. After the procedure, the patient recovered without any neurologic deficit, and CAS has never recurred with isosorbide mononitrate treatment during follow-up. Conclusions CAS is a rare complication associated with AF hybrid procedure. Attention should be paid to this rare but potentially life-threatening complication.
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Affiliation(s)
- Xin Xie
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zijun Chen
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yu Luo
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiaorong Li
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jian Zhou
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jinbo Yu
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
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Celotto C, Sánchez C, Mountris KA, Laguna P, Pueyo E. Location of Parasympathetic Innervation Regions From Electrograms to Guide Atrial Fibrillation Ablation Therapy: An in silico Modeling Study. Front Physiol 2021; 12:674197. [PMID: 34456743 PMCID: PMC8385640 DOI: 10.3389/fphys.2021.674197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
The autonomic nervous system (ANS) plays an essential role in the generation and maintenance of cardiac arrhythmias. The cardiac ANS can be divided into its extrinsic and intrinsic components, with the latter being organized in an epicardial neural network of interconnecting axons and clusters of autonomic ganglia called ganglionated plexi (GPs). GP ablation has been associated with a decreased risk of atrial fibrillation (AF) recurrence, but the accurate location of GPs is required for ablation to be effective. Although GP stimulation triggers both sympathetic and parasympathetic ANS branches, a predominance of parasympathetic activity has been shown. This study aims was to develop a method to locate atrial parasympathetic innervation sites based on measurements from a grid of electrograms (EGMs). Electrophysiological models representative of non-AF, paroxysmal AF (PxAF), and persistent AF (PsAF) tissues were developed. Parasympathetic effects were modeled by increasing the concentration of the neurotransmitter acetylcholine (ACh) in randomly distributed circles across the tissue. Different circle sizes of ACh and fibrosis geometries were considered, accounting for both uniform diffuse and non-uniform diffuse fibrosis. Computational simulations were performed, from which unipolar EGMs were computed in a 16 × 1 6 electrode mesh. Different distances of the electrodes to the tissue (0.5, 1, and 2 mm) and noise levels with signal-to-noise ratio (SNR) values of 0, 5, 10, 15, and 20 dB were tested. The amplitude of the atrial EGM repolarization wave was found to be representative of the presence or absence of ACh release sites, with larger positive amplitudes indicating that the electrode was placed over an ACh region. Statistical analysis was performed to identify the optimal thresholds for the identification of ACh sites. In all non-AF, PxAF, and PsAF tissues, the repolarization amplitude rendered successful identification. The algorithm performed better in the absence of fibrosis or when fibrosis was uniformly diffuse, with a mean accuracy of 0.94 in contrast with a mean accuracy of 0.89 for non-uniform diffuse fibrotic cases. The algorithm was robust against noise and worked for the tested ranges of electrode-to-tissue distance. In conclusion, the results from this study support the feasibility to locate atrial parasympathetic innervation sites from the amplitude of repolarization wave.
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Affiliation(s)
- Chiara Celotto
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Carlos Sánchez
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Konstantinos A. Mountris
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Pablo Laguna
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Esther Pueyo
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
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Aksu T, Yalin K, Bozyel S, Gopinathannair R, Gupta D. The anatomical basis behind the neuromodulation effects associated with pulmonary vein isolation. J Cardiovasc Electrophysiol 2021; 32:1733-1736. [PMID: 33844395 DOI: 10.1111/jce.15038] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
The anatomical basis underlying the neuromodulation effects seen with pulmonary vein (PV) isolation (PVI) is not fully understood. Left atrial (LA) electro-anatomical maps of 38 patients who underwent catheter cardioneuroablation for vagally mediated bradycarrhythmias were studied. During the procedure, LA ganglionic plexi (GPs) were systematically identified and ablated. Design PVI lines were created on these maps by a blinded observer, and the degree of overlap between four GPs and individual PVs was assessed. Here, 1.7 ± 7 (35.5 ± 17.0%) of the total 31.6 ± 10 GP ablation sites per patient were found to overlap with the design PVI lines. The overlap was higher for the right-sided GPs, p < .001. The degree of GP-PV overlap varied: 1 PV in 5 (13.2%) patients, 2 PVs in 15 (39.2%), 3 PVs in 16 (42.1%), and all 4 PVs in 2 (5.3%). No patient had zero GP-PV overlap. A vagal response was most commonly observed during ablation at the left superior GP (89.5%), while a sympathetic response was observed most often during the right superior GP ablation (97.4%). Some degree of GP-PV antral overlap is the norm, and this is more pronounced for the right-sided PVs. There is significant individual variability in the degree of overlap which may explain why neuromodulation effects are not seen universally following PVI.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Rakesh Gopinathannair
- Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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B Hesselson A, Hesselson H. Hemodynamic Management of Patients with Ejection Fraction < 50% Undergoing Pulmonary Vein Ablation. J Atr Fibrillation 2021; 13:20200439. [PMID: 34950346 PMCID: PMC8691288 DOI: 10.4022/jafib.20200439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022]
Abstract
There is no consensus regarding optimal methodology forblood pressure monitoring inpatients with a depressed ejection fraction undergoingcatheter ablationfor atrial fibrillation. Our goalswere to determine ifhemodynamicmanagementdifferences exist during radiofrequency ablation for atrial fibrillation in patients with and without an ejection fraction< 50%, and whether management was influenced by the utilization of invasive arterial blood pressure monitoring. This single-center trial retrospectively compared blood pressure management during catheterablation of atrial fibrillationin all patients with an ejection fraction< 50% over a 2-year span (n=44), and compared to an age-matched cohort with preserved ejection fraction ablated over the same span in time (n=44). Blood pressure was not significantly managed differently between the groups, and did not appear to be influenced by the use of invasive arterial blood pressure monitoring.Hemodynamic management is similar across the spectrum of ejection fraction, regardless of invasive arterial blood pressure monitoring, which challenges the need for invasive arterial blood pressure monitoringduringcatheter ablation ofatrial fibrillationin left ventricular systolic dysfunction.
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Affiliation(s)
- Aaron B Hesselson
- University of Kentucky Division of Cardiovascular Medicine, 900 South Limestone Street, CTW 305D, Lexington, KY 40536
| | - Heather Hesselson
- University of Kentucky, College of Pharmacy, 789 S Limestone, Lexington, KY 40508
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Otsuka N, Okumura Y, Arai M, Kurokawa S, Nagashima K, Watanabe R, Wakamatsu Y, Yagyu S, Ohkubo K, Nakai T, Hao H, Takahashi R, Taniguchi Y, Li Y. Effect of obesity and epicardial fat/fatty infiltration on electrical and structural remodeling associated with atrial fibrillation in a novel canine model of obesity and atrial fibrillation: A comparative study. J Cardiovasc Electrophysiol 2021; 32:889-899. [PMID: 33600010 DOI: 10.1111/jce.14955] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/22/2020] [Accepted: 01/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND How obesity and epicardial fat influence atrial fibrillation (AF) is unknown. METHODS To investigate the effect of obesity/epicardial fat on the AF substrate, we divided 20 beagle dogs of normal weight into four groups (n = 5 each): one of the four groups (Obese-rapid atrial pacing [RAP] group) served as a novel canine model of obesity and AF. The other three groups comprised dogs fed a standard diet without RAP (Control group), dogs fed a high-fat diet without RAP (Obese group), or dogs fed a standard diet with RAP (RAP group). All underwent electrophysiology study, and hearts were excised for histopathologic and fibrosis-related gene expression analyses. RESULTS Left atrial (LA) pressure was significantly higher in the Obese group than in the Control, RAP, and Obese-RAP groups (23.4 ± 6.9 vs. 11.4 ± 2.1, 11.9 ± 6.4, and 13.5 ± 2.9 mmHg; p = .005). The effective refractory period of the inferior PV was significantly shorter in the RAP and Obese-RAP groups than in the Control group (p = .043). Short-duration AF was induced at greatest frequency in the Obese-RAP and Obese groups (p < .05). Epicardial fat/Fatty infiltration was greatest in the Obese-RAP group, and greater in the Obese and RAP groups than in the Control group. %interstitial fibrosis/fibrosis-related gene expression was significantly greater in the Obese-RAP and RAP groups (p < .05). CONCLUSIONS Vulnerability to AF was associated with increased LA pressure and increased epicardial fat/fatty infiltration in our Obese group, and with increased epicardial fat/fibrofatty infiltration in the RAP and Obese-RAP groups. These may explain the role of obesity/epicardial fat in the pathogenesis of AF.
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Affiliation(s)
- Naoto Otsuka
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Masaru Arai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kurokawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryuta Watanabe
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Seina Yagyu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Department of Pathology and Microbiology, Division of Human Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Takahashi
- Institute of Medical Science, Medical Research Support Center, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Institute of Medical Science, Medical Research Support Center, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
| | - Yxin Li
- Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
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11
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Nakamura T, Takami M, Fukuzawa K, Kiuchi K, Kono H, Kobori A, Sakamoto Y, Watanabe R, Okumura Y, Yamashita S, Yamashiro K, Miyamoto K, Kusano K, Kanda T, Masuda M, Yoshitani K, Yoshida A, Hirayama Y, Adachi K, Mine T, Shimane A, Takeda M, Takei A, Okajima K, Fujiwara R, Hirata KI. Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures - Large-Scale Multicenter Analysis. Circ J 2021; 85:264-271. [PMID: 33431721 DOI: 10.1253/circj.cj-20-1096] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae. CONCLUSIONS CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.
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Affiliation(s)
- Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Kono
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital
| | | | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University of Medicine
| | | | | | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kazuyasu Yoshitani
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | | | | | - Takanao Mine
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Akira Shimane
- Department of Cardiology, Himeji Cardiovascular Center
| | | | - Asumi Takei
- Department of Cardiology, Kobe Rosai Hospital
| | | | - Ryudo Fujiwara
- Cardiovascular Division, Osaka Saiseikai Nakatsu Hospital
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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12
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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation. J Clin Med 2020; 9:jcm9103081. [PMID: 32987820 PMCID: PMC7598705 DOI: 10.3390/jcm9103081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.
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13
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Huang X, Chen Y, Huang Y, Zhao H, He L, Tan Z, Xu D, Peng J. Comparative effects of intensive ganglionated plexus ablation in treating paroxysmal atrial fibrillation and vasovagal syncope. Clin Cardiol 2020; 43:1326-1333. [PMID: 32808295 PMCID: PMC7661657 DOI: 10.1002/clc.23446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Ganglionated plexus (GP) ablation is used to treat atrial fibrillation (AF) and vasovagal syncope (VVS). However, the comparative effects of GP ablation in treating paroxysmal atrial fibrillation (PAF) and VVS have not been well studied. OBJECTIVE The purpose of this study was to investigate the effects of intensive GP ablation on PAF and VVS. METHODS PAF and VVS patients were enrolled in this study. Pulmonary vein isolation (PVI) was performed in the PAF group, and additional ablation was performed at GP sites. Anatomic ablation of left atrial GPs was performed in the VVS group. The primary endpoint was freedom from AF or other sustained atrial tachycardia and syncope recurrence. RESULTS A total of 195 patients were enrolled: 146 patients with PAF, including eight patients with combined VVS (PAF group), and 49 patients with VVS (VVS group). Vasovagal response (VR) was achieved in 78 (53.4%) patients in the PAF group and 48 patients (98.0%) in the VVS group (P < .05). During the 17.8 ± 10.5 (range, 3-42) month follow-up, 126 (86.3%) patients were free of AF in the PAF group, and 45 (91.8%) patients in the VVS group had no syncope recurrence and significantly improved symptoms. CONCLUSIONS Anatomically guided intensive GP ablation showed efficient clinical outcomes for both groups of patients. Compared with PAF patients, VVS patients had more VR during ablation in the left atrium. Furthermore, VR during ablation indicated a better prognosis in PAF patients.
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Affiliation(s)
- Xingfu Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanjia Chen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuli Huang
- Department of Cardiology, The First People's Hospital of Shunde, Foshan, China
| | - Hongxin Zhao
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Liwei He
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenni Tan
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dingli Xu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Peng
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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14
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Ashton JL, Argent L, Smith JEG, Jin S, Sands GB, Smaill BH, Montgomery JM. Evidence of structural and functional plasticity occurring within the intracardiac nervous system of spontaneously hypertensive rats. Am J Physiol Heart Circ Physiol 2020; 318:H1387-H1400. [DOI: 10.1152/ajpheart.00020.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We have developed intracardiac neuron whole cell recording techniques in atrial preparations from control and spontaneous hypertensive rats. This has enabled the identification of significant synaptic plasticity in the intracardiac nervous system, including enhanced postsynaptic current frequency, increased synaptic terminal density, and altered postsynaptic receptors. This increased synaptic drive together with altered cardiac neuron electrophysiology could increase intracardiac nervous system excitability and contribute to the substrate for atrial arrhythmia in hypertensive heart disease.
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Affiliation(s)
- Jesse L. Ashton
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Liam Argent
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Joscelin E. G. Smith
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Sangjun Jin
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Gregory B. Sands
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
- Bioengineering Institute, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Bruce H. Smaill
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
- Bioengineering Institute, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Johanna M. Montgomery
- Department of Physiology, Manaaki Mānawa Centre for Heart Research, University of Auckland, Auckland, New Zealand
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15
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Kapa S, Chung M, Gopinathannair R, Noseworthy P, Eckhardt L, Leal M, Wan E, Wang PJ. Year in Review in Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2020; 13:e008733. [PMID: 32423252 DOI: 10.1161/circep.120.008733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past year, there have been numerous advances in our understanding of arrhythmia mechanisms, diagnosis, and new therapies. We have seen advances in basic cardiac electrophysiology with data suggesting that secretoneurin may be a biomarker for patients at risk of ventricular arrhythmias, and we have learned of the potential role of an NPR-C (natriuretic peptide receptor-C) in atrial fibrosis and the role of an atrial specific 2-pore potassium channel TASK-1 as a therapeutic target for atrial fibrillation. We have seen studies demonstrating the role of sensory neurons in sleep apnea-related atrial fibrillation and the association between bariatric surgery and atrial fibrillation ablation outcomes. Artificial intelligence applied to electrocardiography has yielded estimates of age, sex, and overall health. We have seen new tools for collection of patient-centered outcomes following catheter ablation. There have been significant advances in the ability to identify ventricular tachycardia termination sites through high-density mapping of deceleration zones. We have learned that right ventricular dysfunction may be a predictor of survival benefit after implantable cardioverter-defibrillator implantation in patients with nonischemic cardiomyopathy. We have seen further insights into the role of His bundle pacing on improving outcomes. As our understanding of cardiac laminopathies advances, we may have new tools to predict arrhythmic event rates in gene carriers. Finally, we have seen numerous advances in the treatment of arrhythmias in patients with congenital heart disease.
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Affiliation(s)
- Suraj Kapa
- Department of Medicine, Mayo Clinic, Rochester, MN (S.K., P.N.)
| | - Mina Chung
- Department of Medicine, Cleveland Clinic, OH (M.C.)
| | | | | | - Lee Eckhardt
- Department of Medicine, University of Wisconsin, Madison (L.E., M.L.)
| | - Miguel Leal
- Department of Medicine, University of Wisconsin, Madison (L.E., M.L.)
| | - Elaine Wan
- Department of Medicine, Columbia University, New York, NY (E.W.)
| | - Paul J Wang
- Department of Medicine, Stanford University, CA (P.J.W.)
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