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Iwakoshi H, Asada YC, Nakata M, Makino M, Munakata J, Tomura N, Shimoo S, Nishimura T, Shiraishi H, Matoba S, Senoo K. Impact of Sleep Apnea on Nocturnal Parasympathetic Activity in Atrial Fibrillation Patients After Catheter Ablation - Implications for Heart Rate Variability Analysis. Circ J 2024; 88:1081-1088. [PMID: 38281763 DOI: 10.1253/circj.cj-23-0682] [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: 01/30/2024]
Abstract
BACKGROUND The impact of sleep apnea (SA) on heart rate variability (HRV) in atrial fibrillation (AF) patients has not been investigated.Methods and Results: Of 94 patients who underwent AF ablation between January 2021 and September 2022, 76 patients who had a nocturnal Holter electrocardiography and polysomnography conducted simultaneously were included in the analysis. A 15-min duration of HRV, as determined by an electrocardiogram during apnea and non-apnea time, were compared between patients with and without AF recurrence at 12 months' postoperatively. Patients had a mean age of 63.4±11.6 years, 14 were female, and 20 had AF recurrence at 12 months' follow-up. The root mean square of the difference between consecutive normal-to-normal intervals (RMSSD, ms) an indicator of a parasympathetic nervous system, was more highly increased in patients with AF recurrence than those without, during both apnea and non-apnea time (apnea time: 16.7±4.5 vs. 13.5±3.3, P=0.03; non-apnea time: 20.9±9.5 vs. 15.5±5.9, P<0.01). However, RMSSD during an apneic state was decreased more than that in a non-apneic state in both groups of patients with and without AF recurrence (AF recurrence group: 16.7±4.5 vs. 20.9±9.5, P<0.01; non-AF recurrence group; 13.5±3.3 vs. 15.5±5.9, P=0.03). Consequently, the effect of AF recurrence on parasympathetic activity was offset by SA. Similar trends were observed for other parasympathetic activity indices; high frequency (HF), logarithm of HF (lnHF) and the percentage of normal-to-normal intervals >50 ms (pNN50). CONCLUSIONS Without considering the influence of SA, the results of nocturnal HRV analysis might be misinterpreted. Caution should be taken when using nocturnal HRV as a predictor of AF recurrence.
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Affiliation(s)
- Hibiki Iwakoshi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Yusuke C Asada
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Mitsuko Nakata
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Masahiro Makino
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Jun Munakata
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Nobunari Tomura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Satoshi Shimoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Tetsuro Nishimura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Keitaro Senoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Huang J, Chan Y, Tse Y, Yu S, Li H, Chen C, Zhao C, Liu M, Wu M, Ren Q, Leung K, Hung D, Li X, Tse H, Lip GYH, Yiu K. Statin Therapy Is Associated With a Lower Risk of Heart Failure in Patients With Atrial Fibrillation: A Population-Based Study. J Am Heart Assoc 2023; 12:e032378. [PMID: 38014688 PMCID: PMC10727318 DOI: 10.1161/jaha.123.032378] [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] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Whether statin use can reduce the risk of heart failure (HF) remains controversial. The present study evaluates the association between statin use and HF in patients with atrial fibrillation. METHODS AND RESULTS Patients with newly diagnosed atrial fibrillation from 2010 to 2018 were included. An inverse probability of treatment weighting was used to balance baseline covariates between statin users (n=23 239) and statin nonusers (n=29 251). The primary outcome was incident HF. Cox proportional hazard models with competing risk regression were used to evaluate the risk of HF between statin users and nonusers. The median age of the cohort was 74.7 years, and 47.3% were women. Over a median follow-up of 5.1 years, incident HF occurred in 3673 (15.8%) statin users and 5595 (19.1%) statin nonusers. Statin use was associated with a 19% lower risk of HF (adjusted subdistribution hazard ratio, 0.81 [95% CI, 0.78-0.85]). Restricted to the statin users, duration of statin use was measured during follow-up; compared with short-term use (3 months to <2 years), there was a stepwise reduction in the risk of incident HF among those with 2 to <4 years of statin use (subdistribution hazard ratio, 0.86 [95% CI, 0.84-0.88]), 4 to <6 years of statin use (subdistribution hazard ratio, 0.74 [95% CI, 0.72-0.76]), and ≥6 years of statin use (subdistribution hazard ratio, 0.71 [95% CI, 0.69-0.74]). Subgroup analysis showed consistent reductions in the risk of HF with statin use. CONCLUSIONS Statin use was associated with a decreased risk of incident HF in a duration-dependent manner among patients with atrial fibrillation.
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Affiliation(s)
- Jia‐Yi Huang
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Yap‐Hang Chan
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Yi‐Kei Tse
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Si‐Yeung Yu
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Hang‐Long Li
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Cong Chen
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
| | - Chun‐Ting Zhao
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
| | - Ming‐Ya Liu
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
| | - Mei‐Zhen Wu
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Qing‐Wen Ren
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Ka‐Lam Leung
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Denise Hung
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Xin‐Li Li
- Department of CardiologyJiangsu Province Hospital and Nanjing Medical University First Affiliated HospitalNanjingChina
| | - Hung‐Fat Tse
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUnited Kingdom
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Kai‐Hang Yiu
- Division of Cardiology, Department of MedicineThe University of Hong Kong Shen Zhen HospitalHong KongChina
- Division of Cardiology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalHong KongChina
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Anagnostopoulos I, Kousta M, Kossyvakis C, Paraskevaidis NT, Vrachatis D, Deftereos S, Giannopoulos G. Epicardial Adipose Tissue and Atrial Fibrillation Recurrence following Catheter Ablation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6369. [PMID: 37835012 PMCID: PMC10573952 DOI: 10.3390/jcm12196369] [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: 09/08/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
(1)Introduction: Catheter ablation has become a cornerstone for the management of patients with atrial fibrillation (AF). Nevertheless, recurrence rates remain high. Epicardial adipose tissue (EAT) has been associated with AF pathogenesis and maintenance. However, the literature has provided equivocal results regarding the relationship between EAT and post-ablation recurrence.(2) Purpose: to investigate the relationship between total and peri-left atrium (peri-LA) EAT with post-ablation AF recurrence. (3) Methods: major electronic databases were searched for articles assessing the relationship between EAT, quantified using computed tomography, and the recurrence of AF following catheter ablation procedures. (4) Results: Twelve studies (2179 patients) assessed total EAT and another twelve (2879 patients) peri-LA EAT. Almost 60% of the included patients had paroxysmal AF and recurrence was documented in 34%. Those who maintained sinus rhythm had a significantly lower volume of peri-LA EAT (SMD: -0.37, 95%; CI: -0.58-0.16, I2: 68%). On the contrary, no significant difference was documented for total EAT (SMD: -0.32, 95%; CI: -0.65-0.01; I2: 92%). No differences were revealed between radiofrequency and cryoenergy pulmonary venous isolation. No publication bias was identified. (5) Conclusions: Only peri-LA EAT seems to be predictive of post-ablation AF recurrence. These findings may reflect different pathophysiological roles of EAT depending on its location. Whether peri-LA EAT can be used as a predictor and target to prevent recurrence is a matter of further research.
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Affiliation(s)
| | - Maria Kousta
- Cardiology Department, Athens General Hospital “G. Gennimatas”, 11527 Athens, Greece (C.K.)
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital “G. Gennimatas”, 11527 Athens, Greece (C.K.)
| | | | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Bodagh N, Williams MC, Vickneson K, Gharaviri A, Niederer S, Williams SE. State of the art paper: Cardiac computed tomography of the left atrium in atrial fibrillation. J Cardiovasc Comput Tomogr 2023; 17:166-176. [PMID: 36966040 PMCID: PMC10689253 DOI: 10.1016/j.jcct.2023.03.002] [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: 10/17/2022] [Revised: 02/06/2023] [Accepted: 03/11/2023] [Indexed: 03/27/2023]
Abstract
The clinical spectrum of atrial fibrillation means that a patient-individualized approach is required to ensure optimal treatment. Cardiac computed tomography can accurately delineate atrial structure and function and could contribute to a personalized care pathway for atrial fibrillation patients. The imaging modality offers excellent spatial resolution and has been utilised in pre-, peri- and post-procedural care for patients with atrial fibrillation. Advances in temporal resolution, acquisition times and analysis techniques suggest potential expanding roles for cardiac computed tomography in the future management of patients with atrial fibrillation. The aim of the current review is to discuss the use of cardiac computed tomography in atrial fibrillation in pre-, peri- and post-procedural settings. Potential future applications of cardiac computed tomography including atrial wall thickness assessment and epicardial fat volume quantification are discussed together with emerging analysis techniques including computational modelling and machine learning with attention paid to how these developments may contribute to a personalized approach to atrial fibrillation management.
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Affiliation(s)
- Neil Bodagh
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | | | - Keeran Vickneson
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ali Gharaviri
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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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.
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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 ✉
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