P179 Alterations of resting heart rate and heart rate viability after cryoballon ablation in the patients with paroxysmal atrial fibrillation

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
S Sakabe ◽  
K Maeno ◽  
H Yamagishi ◽  
K Unno ◽  
T Mori ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Vena Cava ◽  
Male Gender ◽  
Cryoballoon Ablation ◽  
Resting Heart Rate ◽  
Cardiac Autonomic Nervous System ◽  
Significant Difference ◽  
Before And After

Abstract Background While it is generally accepted that cardiac autonomic nervous system (CANS) plays an important role in atrial fibrillation (AF) and pulmonary vein isolation (PVI) by radiofrequency catheter ablation modifies the ganglionated plexi (GP), the alterations of CANS after PVI are not clarified. Purpose The objective of this study was to investigate the alteration of CANS after conventional cryoballoon ablation (CBA) by using a non-invasive examination method of measuring resting heart rate (R-HR) and coefficient of variation of R-R interval (CVR-R) which is a representative parameter of heart rate viability. CVR-R reflects R-R interval variation affected by respiration. It is calculated from the R-R interval of consecutive 100 heart beats of sinus rhythm recorded at rest. Declines of CVR-R indicate the parasympathetic dysfunction and the normal range of it varies depend on the age. As age increases from 30s to 70s, the average value of CVR-R decreases from 4.0% to 2.4%. Methods Consecutive patients of paroxysmal AF treated with initial CBA in our institute participated. Subjects were limited to the patients who maintained sinus rhythm through the study and whose prescription had not been changed after procedure. All patients recorded 12-lead electrocardiogram to measure R-HR and CVR-R before and the day after the procedure. We compared R-HR and CVR-R of all patients before and after CBA. And in addition, we compared them in each of two groups whose pre-procedural H-RH were under 50 bpm (Group-U50) and over 70 bpm (Group-O70). All procedures were performed with second generation 28mm cryoballoon (CB)s under the conscious sedation with Dexmedetomidine. CB temperature was down to a minimum of -60°C and target application time was 180 seconds. Results In the procedure of all 105 patients (male gender, 54%; age, 66.9 ± 10.4years; CHADS2score, 1.15 ± 1.04; diabetes mellitus,14%; beta-blocker therapy, 16%), 1 of touch-up for PVI, 6 of supra vena cava isolation and 21 of cavotricuspid isthmus linear ablations with radiofrequency catheter were added. In all patients, R-HR increased from 58.9 ± 9.2bpm to 72.4 ± 9.5bpm (P < 0.01) and CVR-R decreased from 2.36 ± 1.08% to 1.24 ± 0.68% (P < 0.01), respectively. In Group-U50 (n = 14; male gender 64%; age 67.6 ± 12.4 years), R-HR increased from 47.1 ± 2.1bpm to 64.4 ± 7.9bpm (P < 0.01) and CVR-R decreased from 2.58 ± 1.59% to 1.34 ± 0.82% (P < 0.01), respectively. In Group-O70 (n = 17; male gender 43%; age 67.4 ± 12.6 years), R-HR increased from 73.7 ± 2.8bpm to 81.8 ± 7.4bpm (P < 0.01) and CVR-R decreased from 2.33 ± 0.94% to 1.14 ± 0.52% (P < 0.01), respectively. Values of CVR-R before and after CBA showed no significant difference between the two groups. Conclusions After CBA, R-HR increment and CVR-R decrement were significantly observed. CVR-R was halved regardless of pre–procedural R-HR. Damages to GP by CBA would be reflected as denervation of vagus nerves in CANS. R-HR increase might be associated with parasympathetic suppression of CANS.

Prognostic value of the heart rate profile during exercise in patients with atrial fibrillation

2018 ◽  
Vol 25 (15) ◽  
pp. 1634-1641 ◽  
Author(s):  
Kazufumi Aihara ◽  
Yuko Kato ◽  
Shinya Suzuki ◽  
Takuto Arita ◽  
Naoharu Yagi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Exercise Capacity ◽  
Resting Heart Rate ◽  
Peak Heart Rate ◽  
Chronotropic Response ◽  
Response Peak ◽  
Rate Profile

Aims This study aimed to investigate the correlation of heart rate profile during exercise with exercise capacity and heart failure occurrence in patients with atrial fibrillation compared with patients with sinus rhythm. Methods We analyzed 2231 patients (atrial fibrillation: n = 321, sinus rhythm: n = 1910) who underwent a symptom-limited maximal cardiopulmonary exercise test at our institute. Their heart rate profile during exercise was assessed using peak heart rate and chronotropic response; (peak heart rate−resting heart rate)/(220−age−resting heart rate). The endpoint was the occurrence of heart failure events, defined as hospitalization for heart failure or heart failure-related death. Results There were significant positive correlations of peak heart rate and chronotropic response to peak oxygen consumption, both in atrial fibrillation and sinus rhythm. During a median follow-up period of 1262 (interquartile range 974–2921) days, 117 (5.2%) heart failure events were observed. Multivariate analyses showed that peak heart rate and chronotropic response were statistically significant predictors of heart failure events both in atrial fibrillation (peak heart rate: heart rate 0.975, p = 0.002, chronotropic response: heart rate 0.196, p = 0.003) and in sinus rhythm (peak heart rate: heart rate 0.988, p = 0.036, chronotropic response: heart rate 0.347, p = 0.020). Bivariate models showed that compared with chronotropic response, peak heart rate was a stronger predictor of heart failure in atrial fibrillation, whereas the finding was reversed in sinus rhythm. Conclusion The exercise- heart rate profile was significantly related to exercise capacity and future heart failure events, regardless of rhythm. However, the impacts of peak heart rate and chronotropic response on the endpoint varied according to the cardiac rhythm.

scholarly journals Heartbeat Cycle Length Detection by a Ballistocardiographic Sensor in Atrial Fibrillation and Sinus Rhythm

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Matthias Daniel Zink ◽  
Christoph Brüser ◽  
Patrick Winnersbach ◽  
Andreas Napp ◽  
Steffen Leonhardt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Quality Index ◽  
Cycle Length ◽  
Heart Rate Monitoring ◽  
Mechanical Vibrations ◽  
Before And After ◽  
Registration Number ◽  
Novel Algorithm

Background.Heart rate monitoring is especially interesting in patients with atrial fibrillation (AF) and is routinely performed by ECG. A ballistocardiography (BCG) foil is an unobtrusive sensor for mechanical vibrations. We tested the correlation of heartbeat cycle length detection by a novel algorithm for a BCG foil to an ECG in AF and sinus rhythm (SR).Methods.In 22 patients we obtained BCG and synchronized ECG recordings before and after cardioversion and examined the correlation between heartbeat characteristics.Results.We analyzed a total of 4317 heartbeats during AF and 2445 during SR with a correlation between ECG and BCG during AF ofr=0.70(95% CI 0.68–0.71,P<0.0001) andr=0.75(95% CI 0.73–0.77,P<0.0001) during SR. By adding a quality index, artifacts could be reduced and the correlation increased for AF to 0.76 (95% CI 0.74–0.77,P<0.0001,n=3468) and for SR to 0.85 (95% CI 0.83–0.86,P<0.0001,n=2176).Conclusion.Heartbeat cycle length measurement by our novel algorithm for BCG foil is feasible during SR and AF, offering new possibilities of unobtrusive heart rate monitoring. This trial is registered with IRB registration number EK205/11. This trial is registered with clinical trials registration numberNCT01779674.

The relationship between resting heart rate and peak VO2: A comparison of atrial fibrillation and sinus rhythm

2016 ◽  
Vol 23 (13) ◽  
pp. 1429-1436 ◽  
Author(s):  
Yuko Kato ◽  
Shinya Suzuki ◽  
Tokuhisa Uejima ◽  
Hiroaki Semba ◽  
Osamu Nagayama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Resting Heart Rate ◽  
Peak Vo2 ◽  
The Relationship

Abstract P198: Connected Health Remote Monitoring in Atrial Fibrillation Care Management

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Robert Scales ◽  
Kathryn Lew ◽  
Colin Parker ◽  
Aasaf Raad ◽  
Steven Lester
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Remote Monitoring ◽  
Hospital Readmission ◽  
Care Management ◽  
Resting Heart Rate ◽  
Communication Platform ◽  
Connected Health

Background: Avoiding early hospital readmission after a diagnosis of atrial fibrillation (AF) lowers healthcare costs. Purpose: This investigation pilot tested the process of using a Connected Health (CH) communication platform in AF care management. Subjects: A self-selected group of patients (n=18, 56% male, mean age=69 years, SD =12.6) diagnosed with hemodynamically stable AF and an uncontrolled ventricular response with heart rates > 110 bpm were recruited. MethodS: Eligibility criteria included a recent AF related emergency department or outpatient clinic visit and the new prescription of a rate control medication. This included AV node modifying medications (either a beta blocker or nondihydropyradine calcium channel blocker) at a starting dose determined by the supervising physician. A care management team (CMT) coordinated by a nurse practitioner provided individualized telephone medical management with no planned clinical visits during a period of early recovery. Patients were equipped with the AliveCor TM Kardia electrocardiogram (ECG) home monitoring device and a supporting mobile device application. Patients returned home with medical guidance from the CMT and ECG recording instructions. Heart rate and rhythm were monitored remotely by the NP and the medication dose was adjusted to reach a target resting heart rate <110 bpm. Patients were managed for 3-weeks before being discharged back to primary care or outpatient cardiology for consideration of a rate versus rhythm control strategy if spontaneous restoration of sinus rhythm had not occurred. ResultS: Patients recorded an average of 50 ( SD =40.0) ECG tracings with a mean of 13 ( SD =3.79) related CMT telephone contacts. The mean resting heart rate was significantly lower ( p <0.05) at the completion of the intervention (72.9 bpm, SD =17.31) compared to baseline (102.3 bpm, SD =27.17). All of the AF patients achieved adequate heart rate control or spontaneously returned to sinus rhythm. However, 4 patients (22%) required a related emergency room visit and unplanned hospitalization. Conclusion: In this small feasibility study, an electronic healthcare device (biosensor) paired with a mobile-heath application provided a practical remote monitoring communication platform to support tele-management, but the intervention did not prevent hospital readmission. Future Directions: Further research is needed to identify factors that will improve the process of applying CH to AF care management.

P1917Can cryoballoon ablation produce alterations in cardiac and extra-cardiac autonomic nervous system in patients with atrial fibrillation?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Sakabe ◽  
K Unno ◽  
T Mori ◽  
M Horiguchi ◽  
T Takamura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Male Gender ◽  
Cryoballoon Ablation ◽  
Chads2 Score ◽  
Blocker Therapy ◽  
Cardiac Autonomic Nervous System ◽  
Autonomic Nervous ◽  
Ganglionated Plexi ◽  
Before And After ◽  
Β Blocker

Abstract Background Cryoballoon ablation (CBA) during pulmonary vein isolation (PVI) for atrial fibrillation (AF) can cause direct thermal injury to structures adjacent to the left atrium, including the periatrial ganglionated plexi (GP). In contrast, it has not been clarified whether cardiac autonomic nervous system (CANS) modification by CBA could indirectly affect extra-CANS. Purpose This study was aimed to investigate the impact of CBA on extra-CANS as well as CANS in AF patients. Methods Ninety-three Consecutive patients who underwent initial CBA in our institute were enrolled. Among them, 64 subjects (age 67±9 years; male gender 52%; CHADS2 score 1.2±1.0; diabetes mellitus 16%; β-blocker therapy 23%) had paroxysmal AF (G-P) and 29 (age 66±7 years; male gender 90%; CHADS2 score 1.3±1.0; diabetes mellitus 24%; β-blocker therapy 34%) had sustained AF (G-S). In G-P, resting sinus heart rate (R-HR) and coefficient of variation of the R-R intervals (CVR-R) during sinus rhythm were measured in resting 12-lead electrocardiogram before and after CBA as an index of CANS. Decrease in CVR-R after PVI reflects the vagal nerve injury by the procedure. Pupil movement reflects the autonomic nervous function. In both groups, pupillary light reflex, as an indicator of extra-CANS activity, was measured by infrared videopupillography (Iriscorder® Dual C10641, Hamamatsu Photonics, Hamamatsu, Japan) before and after CBA. Velocity of dilatation (VD) is related to sympathetic function, and velocity of contraction (VC) is associated with the balance between sympathetic and vagal tone. All CBA were treated with second generation 28mm cryoballoons (CB). CB temperature was down to a minimum of −60°C and target application time was 180 seconds. Results Complete PVI was achieved in all patients, in which touch-up radiofrequency ablation for the PVI was required in 4 cases of G-S. In G-P, R-HR significantly increased (59.2±9.2bpm to 72.5±8.3bpm, p<0.01) and CVR-R significantly decreased (2.32±1.1% to 1.61±0.61%, p<0.01) after CBA, while VC and VD did not significantly change (3.83±1.03mm2/sec to 3.64±0.96mm2/sec and 1.83±0.62mm2/sec to 1.86±0.84mm2/sec, respectively). In G-S, there were not significant changes between before and after CBA in VC and VD (3.77±0.80mm2/sec to 3.71±0.99mm2/sec and 1.81±0.49mm2/sec to 1.80±0.59mm2/sec, respectively). There were no significant differences between two groups in VC and VD before the procedure. Conclusion These results suggest that CBA seems to result in local parasympathetic denervation due to damage of adjacent structures including ganglionated plexi while the alteration of CANS by CBA does not seem to efferently affect extra-CANS.

scholarly journals THE RELATIONSHIP BETWEEN RESTING HEART RATE AND PEAK VO2: A COMPARISON OF ATRIAL FIBRILLATION AND SINUS RHYTHM

2016 ◽  
Vol 67 (13) ◽  
pp. 1640
Author(s):  
Yuko Kato ◽  
Shinya Suzuki ◽  
Hiroaki Semba ◽  
Hiroto Kano ◽  
Shunsuke Matsuno ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Resting Heart Rate ◽  
Peak Vo2 ◽  
The Relationship

scholarly journals Resting heart rate, functional capacity and prognosis in heart failure patients: atrial fibrillation versus sinus rhythm

2019 ◽  
Vol 4 (4) ◽  
Author(s):  
Rita Ilhão Moreira ◽  
Tiago Pereira da Silva ◽  
António Valentim Gonçalves ◽  
Joana Feliciano ◽  
Pedro Rio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Functional Capacity ◽  
Resting Heart Rate ◽  
Heart Failure Patients

scholarly journals Efficacy and safety of intravenous beta-blockers in acute atrial fibrillation and flutter is dependent on beta-1 selectivity: a systematic review and meta-analysis of randomised trials

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Perrett ◽  
N Gohil ◽  
O Tica ◽  
K.V Bunting ◽  
D Kotecha
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Heart Rate ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Target Heart Rate ◽  
Significant Difference

Abstract Background Intravenous (IV) beta-blockers are commonly used to manage patients with acute atrial fibrillation (AF) and atrial flutter (AFl). Important pharmacodynamic differences exist amongst beta-blockers, and the choice of beta-blocker or other therapy is often not evidence-based. Purpose Systematic review and meta-analysis of randomised controlled trials (RCTs) in the setting of acute AF/AFl to assess the efficacy and safety of IV beta-blockers against other pharmacological interventions (diltiazem, verapamil, digoxin, anti-arrhythmic drugs or placebo). Methods Prospectively registered (PROSPERO: CRD42020204772). MEDLINE, EMBASE and Cochrane Register were searched from inception to August 2020. The primary outcomes were reduction in heart rate and proportion of patients achieving study-defined target heart rate. Secondary outcomes included conversion to sinus rhythm and incidence of adverse events. Beta-blockers were divided according to beta-1 adrenoreceptor selectivity. Meta-analysis was performed to calculate risk ratios (RR) and standardised mean differences (SMD) using random-effects, and fixed-effects within beta-1 subgroups. Results From 5974 studies, 12 RCTs were included with variable risk of bias, encompassing 1152 participants with mean age 62 years, 38% women and baseline heart rate 137 beats/minute. With high heterogeneity (I2=87%; p&lt;0.001), there was no difference in the reduction in heart rate between beta-blockers and comparators (SMD −0.65, 95% CI −1.63–0.21; p=0.19), and no difference in the proportion that achieved target heart rate (RR 0.85, 95% CI 0.36–1.97; p=0.70). Analysis by beta-1 selectivity demonstrated that conventional beta-1 blockers (metoprolol, esmolol) were inferior for target heart rate reduction (RR 0.33, 95% CI 0.17–0.64; p=0.001), whereas super-selective agents (landiolol) were superior (RR 1.98, 95% CI 1.54–2.54; p&lt;0.001). There was no difference in the rate of conversion to sinus rhythm between beta-blockers and comparators (RR 1.15, 95% CI 0.92–1.44; p=0.21). Adverse events were similar in both groups overall, with no significant difference in hypotension (RR 1.74, 95% CI 0.85–3.58; p=0.13), bradycardia (RR 0.86, 95% CI 0.19–3.81; p=0.153) or events leading to drug discontinuation (RR 1.16, 95% CI 0.26–5.15; p=0.84). Assessment by beta-1 selectivity showed that hypotension and bradycardia were more frequent with non-selective beta-blockers (sotalol) than comparators (RR 4.57, 95% CI 1.92–10.85; p=0.001 and 5.97, 95% CI 1.34–26.57; p=0.019). Conclusion There is no difference between IV beta-blockers overall and other medications for the control of acute AF/AFl, although better efficacy was shown for beta-blockers with higher beta-1 selectivity. IV beta-blockers were as safe as comparator agents, with the exception of non-selective beta-blockers. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Independent systematic review commissioned by Amomed Pharma. Target heart rate and hypotension events

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