Author + information
- Hidekazu Kondo, MD, PhD∗ (, )
- Tetsuji Shinohara, MD, PhD,
- Akira Fukui, MD, PhD,
- Miho Miyoshi, MD,
- Yumi Ishii, MD,
- Toyokazu Otsubo, MD,
- Yasushi Teshima, MD, PhD,
- Kunio Yufu, MD, PhD,
- Mikiko Nakagawa, MD, PhD and
- Naohiko Takahashi, MD, PhD
- ↵∗Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu 1-2, Oita 879-5593, Japan
Pulmonary vein antrum isolation (PVAI) by radiofrequency catheter ablation (RFCA) could unexpectedly transect the sites where the major atrial ganglionated plexi are located, which affects the cardiac autonomic function (1). The evaluation of baroreflex sensitivity (BRS) is an established tool for assessing autonomic control of the cardiovascular system (2). Measurement of the BRS is therefore a source of valuable information in the clinical management of patients with cardiac disease, particularly in terms of risk stratification. However, the alteration of periprocedural BRS in atrial fibrillation (AF) ablation has been unknown. We thus prospectively evaluated the effects of PVAI by RFCA on the BRS and investigated whether there is a relation between periprocedural BRS and AF recurrence in patients with paroxysmal AF.
This study prospectively enrolled 45 consecutive patients with paroxysmal AF who underwent AF ablation (PVAI by RFCA) at our institutions between October 2015 and November 2017. Their mean age was 64.9 ± 11.0 years. The study group comprised 12 female patients and 33 male patients. Patients with previous AF ablation, cardiovascular implantable electronic devices, inability to measure BRS during sinus rhythm because of frequent premature beats, and changes in cardiac medications during enrollment were excluded from the study. All antiarrhythmic drugs were discontinued for at least 5 half-lives before the measurement of the baseline BRS. Amiodarone was not prescribed for any of the patients. The study was conducted at the University of Oita and was approved by the institutional review boards at the institutions. Informed consent was obtained from all patients.
For BRS assessment, arterial systolic blood pressure (SBP) was recorded noninvasively by using tonometry, and the 12-lead electrocardiograms were monitored simultaneously. BRS was assessed by using the phenylephrine method. It was calculated as the slope of the linear regression line and related changes in SBP to changes in the RR interval. Follow-up was conducted at 1, 3, 6, and 12 months after RFCA using a 12-lead electrocardiogram and 24-h Holter monitoring at each visit. Any atrial tachyarrhythmia lasting ≥1 min was considered as a recurrence. The maximum follow-up period was 12 months.
Data are presented as mean ± SD. Given the skewed nature of the data, differences between the 2 groups were analyzed by using nonparametric tests. A p value < 0.05 was considered significant. All computations were performed by using JMP version 12 (SAS Institute, Inc., Cary, North Carolina).
The representative images describing the changes in BRS after ablation are shown in Figure 1A. At baseline, the RR interval was prolonged in proportion to the rise in blood pressure by administration of phenylephrine (left). After ablation, however, the prolongation of the RR interval was dramatically attenuated despite the increase in SBP in this patient (right). In all cases, the value of BRS was reduced after the PVAI (5.5 ± 4.3 vs. 0.6 ± 1.3 ms/mm Hg; p < 0.0001) (Figure 1B). In addition, the difference in BRS before and after ablation (ΔBRS) of patients without AF recurrence was significantly greater than that of patients with AF recurrence (p = 0.0186) (Figure 1C).
As with other parameters such as heart rate variability that indicate cardiac autonomic function, PVAI by RFCA could also drastically affect the BRS, which is reportedly a parameter of cardiovascular parasympathetic activity (3). We focused on the prognostic ability of ΔBRS to predict AF recurrence because it has been reported that cardiac autonomic modification (change of heart rate variability) is related to a higher success rate of the procedure (4). Consistent with these results, a lack of decrease in BRS after the RFCA may predict procedural failure.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- 2019 American College of Cardiology Foundation