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Cui J, Gonzalez MD, Blaha C, Hill A, Sinoway LI. Sympathetic responses induced by radiofrequency catheter ablation of atrial fibrillation. Am J Physiol Heart Circ Physiol 2019; 316:H476-H484. [PMID: 30525895 DOI: 10.1152/ajpheart.00470.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiofrequency catheter ablation (RFCA) is a frequently performed procedure in patients with atrial fibrillation. Prior studies have shown that the RFCA may directly stimulate vagal afferents during the procedure, whereas the vagal tone assessed by heart rate variability (HRV) is lowered weeks after the RFCA procedure. The effects of RFCA performed in the left atrium on sympathetic nerve activity have not been assessed. In the present study, we hypothesized that RFCA would lower muscle sympathetic nerve activity (MSNA) during ablation and would raise MSNA 1 day postablation. A total of 18 patients were studied. In protocol 1 ( n = 10), electrocardiogram, blood pressure, and MSNA in the peroneal nerve were recorded through the RFCA procedure performed in the electrophysiology laboratory. In protocol 2, eight patients were studied before the procedure and 1 day postablation. RFCA led to a decrease in MSNA immediately after the procedure (25.4 ± 3.2 to 17.2 ± 3.8 bursts/min, P < 0.05). Cardiac parasympathetic activity was determined using indexes of HRV and increased during the procedure. One day postablation, MSNA was above baseline values (21.3 ± 3.7 to 35.7 ± 2.6 bursts/min, P < 0.05). HRV indexes of cardiac parasympathetic activity fell, and the HRV index of sympathovagal balance was not significantly altered. The results show that RFCA raised cardiac parasympathetic activity and decreased MSNA during the procedure. One day postablation, MSNA rose and cardiac parasympathetic activity fell. In addition, RFCA evokes differentiated sympathetic responses directed to the heart and skeletal muscles. NEW & NOTEWORTHY The effects of radiofrequency catheter ablation performed in the left atrium on muscle sympathetic nerve activity (MSNA) have not been assessed. The results of this study show that radiofrequency catheter ablation raised cardiac parasympathetic activity and decreased MSNA during the procedure. One day postablation, MSNA rose and cardiac parasympathetic activity fell. We speculate that the partial autonomic afferent denervation induces these effects on autonomic activity.
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Affiliation(s)
- Jian Cui
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Mario D Gonzalez
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Cheryl Blaha
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Ashley Hill
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
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Futami M, Fujimi K, Ueda T, Matsuda T, Fujita M, Kaino K, Sakamoto M, Horita T, Koyoshi R, Arimura T, Shiga Y, Kuwano T, Kitajima K, Saku K, Miura SI. Cardiac rehabilitation in patients with cardiovascular disease leads various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels. IJC HEART & VASCULATURE 2017; 17:23-29. [PMID: 29201997 PMCID: PMC5699897 DOI: 10.1016/j.ijcha.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022]
Abstract
We evaluated whether comprehensive cardiac rehabilitation (CR) in patients with cardiovascular disease (CVD) could improve various hemodynamic parameters obtained using simple non-invasive tests. We analyzed 48 CVD patients with (n = 38, CR group) or without (n = 10, non-CR group) a CR program, and prospectively followed them for 12 months. Various parameters were measured at baseline and after 12 months using 3 simple non-invasive tests: blood pressure (BP) and severity of atherosclerosis [arterial velocity pulse index (AVI) and atrial pressure volume index] were determined using PASESA®, an index of total autonomic nerve activity and a coefficient of variation of the R-R interval (CVRR) were determined using eHEART®, and the total peripheral resistance, stroke volume and cardiac index (CI) were determined using nico®. The main hemodynamic parameters did not change between baseline and 12 months in both groups. Patients in the CR group were divided into higher (H-) and lower (L-) systolic BP (SBP) or AVI according to the average value of SBP or AVI at baseline in the CR group. Patients with H-SBP or H-AVI in the CR group showed a significant reduction of SBP or AVI at 12 months. In addition, patients in the CR group were divided into H- and L- CI or CVRR according to the average value of CI or CVRR at baseline in the CR group. Patients with L-CI or L-CVRR in the CR group significantly improved after 12 months. In conclusion, CR may lead various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels.
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Affiliation(s)
- Makito Futami
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maaya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Rie Koyoshi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
- Corresponding author at: Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.Department of CardiologyFukuoka University School of MedicineFukuokaJapan
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Ueda T, Miura SI, Fujimi K, Ishida T, Matsuda T, Fujita M, Ura Y, Kaino K, Sakamoto M, Horita T, Arimura T, Shiga Y, Kuwano T, Kitajima K, Saku K. Assessment of various parameters using simple non-invasive tests in patients with cardiovascular diseases with or without cardiac rehabilitation. IJC HEART & VASCULATURE 2016; 12:63-67. [PMID: 28616545 PMCID: PMC5454171 DOI: 10.1016/j.ijcha.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
Cardiac rehabilitation (CR) improves cardiac function and exercise capacity in patients with cardiovascular disease (CVD). Simpler techniques are needed for use by physicians in the examination room to assess the usefulness of CR. We enrolled 46 consecutive CVD patients in a CR program (CR group) and prospectively followed them for 3 months. We compared them to 18 age-, gender- and body mass index-matched CVD patients without CR (non-CR group). Various parameters were measured at baseline and after 3 months using 3 simple non-invasive tests: severity of atherosclerosis [arterial velocity pulse index and arterial pressure volume index (API)] were determined using PASESA®, an autonomic nerve total activity amount index and a coefficient of variation of the R–R interval (CVRR) were determined using eHEART®, and peripheral resistance index, pressure rate product, stroke volume and cardiac index were determined using nico®]. There were no significant differences in patient characteristics including percentages (%) of ischemic heart disease and heart failure between the non-CR and CR groups. Systolic blood pressure (SBP), diastolic BP, heart rate and API at baseline significantly decreased and CVRR at baseline significantly increased after 3 months in the CR group, but not in the non-CR group. In addition, ΔAPI (Δ = the value after 3 months minus the value at baseline) was positively associated with ΔSBP in the CR group. In conclusion, CR significantly decreased BP and improved atherosclerosis and sympathetic nerve activity. These findings suggest that simple non-invasive tests may be useful for assessing the effects of CR.
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Affiliation(s)
- Takashi Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Toshihisa Ishida
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshiyuki Ura
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Abrootan S, Yazdankhah S, Payami B, Alasti M. Changes in Heart Rate Variability Parameters after Elective Percutaneous Coronary Intervention. J Tehran Heart Cent 2015; 10:80-4. [PMID: 26110006 PMCID: PMC4477091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/28/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with chronic stable angina often have a state of sympathetic hyperactivity. It is considered associated with myocardial ischemia and disappears after ischemia elimination. The aim of this study was to investigate the changes in heart rate variability parameters, a noninvasive technique for the evaluation of the autonomic nervous system activity, after successful revascularization in these patients to evaluate this theory. METHODS The patients were enrolled among those who underwent successful percutaneous coronary intervention. Short-term heart rate variability analyses of all the patients were obtained, and time-domain indices (standard deviation of normal-to-normal intervals [SDNN], standard deviation of differences of successive R-R intervals [SDSD], root-mean square differences of successive R-R intervals [rMSSD], percentage of R-R intervals differing > 10 ms from the preceding one [PNN10], percentage of R-R intervals differing > 20 ms from the preceding one [PNN20], percentage of R-R intervals differing > 30 ms from the preceding one [PNN30], percentage of R-R intervals differing > 40 ms from the preceding one [PNN40], percentage of R-R intervals differing > 50 ms from the preceding one [PNN50], percentage of R-R intervals differing > 60 ms from the preceding one [PNN60], and percentage of R-R intervals differing > 70 ms from the preceding one [PNN70]) were analyzed. All the measurements were made before and after percutaneous coronary intervention. RESULTS This study included 64 patients, comprising 27 men and 37 women at a mean age of 56.8 ± 9.1 years. There was a significant difference only between pre- and post-revascularization SDNN (27.5 ± 19.72 vs. 41 ± 41.4; p value = 0.013). The other parameters showed no significant differences after successful coronary intervention. Conclusion : Our data indicate that the increase in SDNN in patients with stable angina pectoris undergoing percutaneous coronary intervention seems to be prominent.
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Affiliation(s)
- Saeed Abrootan
- Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Saeed Yazdankhah
- Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Babak Payami
- Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mohammad Alasti
- Department of Cardiology, Bahman General Hospital, Tehran, Iran.,Corresponding Author: Mohammad Alasti, Department of Cardiology, Bahman General Hospital, Iranzamin Avenue, Tehran, Iran. 6193673166. Fax: +98 21 22075778. Tel: +98 21 22075778.
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