Effect of pulmonary vein isolation on left atrial remodeling and muscle sympathetic nerve activity in patients with atrial fibrillation

Abstract Background Catheter ablation (CA) for atrial fibrillation (AF) improves left ventricular function and induces left atrium reverse remodeling (LARR). CA is also associated with the modulation of ganglionated plexi in the left atrium (LA), including stretch-sensitive sympathetic and parasympathetic nerve mechanoreceptors. Increased filling pressure and enlargement of LA stimulate stretch-sensitive sympathetic nerve mechanoreceptors in heart failure, which contribute augmented sympathetic nerve activity. However, little is known about an effect of CA on the interaction between the changes of LARR and sympathetic nerve activity. Purpose To test the hypothesis that CA induce the reduction in sympathetic nerve activity in accordance with LARR in patients with atrial fibrillation. Methods This study was conducted as a retrospective, observational study. Twenty-eight AF patients (65.4±12.1 years old) were included in this study. We measured mean blood pressure (BP), heart rate (HR), brain natriuretic peptide (BNP), and direct recording of muscle sympathetic nerve activity (MSNA) using microneurography technique before and 12 weeks after CA. Echocardiogram was also performed to assess LARR and left ventricular function. To evaluate the interaction between LARR and MSNA, AF patients were divided into two groups by presence (LARR group; n=18) and absence (no LARR group; n=10) of LARR according to left atrium volume index (LAVi) following CA. Results No significant differences were observed at baseline in BP, MSNA and LAVi between two groups. BP did not change significantly after CA in both groups. HR significantly increased in the LARR group (63.1±5.7 vs 69.9±7.8, p<0.01) compared to no LARR group. CA significantly reduced MSNA in the LARR group (37.8±10.1 vs 24.9±8.8 bursts/min, p<0.01), but there was no significant change in the no LARR group. The septal E/e' ratio (11.3±3.8 vs 9.8±2.9, p<0.05), left ventricular end-systolic volume index (LVESVi) (24.4±11.9 vs 19.6±7.8 ml/m2, p<0.05) and Ln BNP (4.0±1.2 vs 3.3±1.0 log/pg/ml, p<0.05) were also significantly improved in the LARR group. On the other hand, in the no LARR group, there were no significancy in the changes of the septal E/e' ratio, LVESVi and Ln BNP. LVEF was not significantly changed in both two groups. Conclusion Our study shows CA reduced MSNA accompanied by LARR in AF patients. The reduction in MSNA, septal E/e' ratio, LVESVi and Ln BNP were all more pronounced in the LARR group compared to the no LARR group. These findings suggest that LARR is associated with the reduction in MSNA in AF patients, which was attributed to CA-induced modulation of stretch-sensitive sympathetic nerve mechanoreceptors. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract 16096: Successful Pulmonary Vein Isolation Improve Diastolic Dysfunction and Sympathetic Nerve Activity in Atrial Fibrillation Patients

Circulation ◽

10.1161/circ.142.suppl_3.16096 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yusuke Mukai ◽

Hisayoshi Murai ◽

Tadayuki Hirai ◽

Takuto Hamaoka ◽

Yoshitaka Okabe ◽

...

Keyword(s):

Atrial Fibrillation ◽

Diastolic Dysfunction ◽

Sympathetic Nerve ◽

Sympathetic Nerve Activity ◽

Muscle Sympathetic Nerve Activity ◽

Left Ventricular ◽

High Rate ◽

Reverse Remodeling ◽

Nerve Activity ◽

Acceleration Rate

Introduction: Atrial fibrillation (AF) is associated with diastolic dysfunction (DD) at a high rate and the presence of left ventricular DD is also associated with increased muscle sympathetic nerve activity (MSNA). Catheter ablation (CA) of AF was reported to improve cardiac function, including the reverse remodeling of left ventricle and atrium. However, little is known about the effect of CA on MSNA and DD in AF patients. Purpose: The purpose of this study was to evaluate the effect of CA on MSNA and DD and the difference in therapeutic effect between two groups with and without DD. Methods: This study was conducted as a prospective, observational study. AF patients who were scheduled for CA were enrolled. The patients were divided into two groups, E/e’ ratio≧11 and <11. We measured blood pressure, HR, body weight, echocardiogram parameters, and MSNA before and 12 weeks after CA. Results: 28 AF patients participated in this study. After CA, in the patients with DD(the group of E/e’≧11, n=12), E/e’ ratio, the MSNA burst incidence(BI) and frequency(BF) were significantly decreased (13.4±2.1 to 10.6±3.0, p<0.01. 64.4±15.8 to 34.0±12.0 bursts/100beats, P<0.01, 39.7±9.3 to 23.5±9.2 bursts/min, p<0.01 respectively). In the patients without DD (the group of E/e’<11, n=16), the BI and BF were significantly decreased (59.7±11.8 to 43.5±11.7 bursts/100beats, P<0.01, 38.1±10.5 to 29.2±8.4 bursts/min, p<0.01 respectively) while there was no difference in E/e’ ratio. Interestingly, in the patients with DD, decrease in BI and BF were more pronounced compared in the patients without DD(-30.4±15.9 to -16.2±11.5 bursts/100beats, P<0.05. -16.3±11.5 to -8.9±13.8 bursts/min, P=0.145 respectively). In both groups, no significant changes were observed in EF and peak acceleration rate of mitral E velocity. Conclusion: CA reduced MSNA in AF patients. In the patients with DD, the reduction of MSNA tended to be more remarkable than without DD. These findings suggest that changes of MSNA might reflect the improvement of DD and reduction of AF burden.

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Comparative effects of nicorandil with isosorbide mononitrate on cardiac sympathetic nerve activity and left ventricular function in patients with ischemic cardiomyopathy

American Heart Journal ◽

10.1016/j.ahj.2005.06.030 ◽

2005 ◽

Vol 150 (3) ◽

pp. 477.e1-477.e8 ◽

Cited By ~ 16

Author(s):

Shu Kasama ◽

Takuji Toyama ◽

Takashi Hatori ◽

Hisao Kumakura ◽

Yoshiaki Takayama ◽

...

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

Sympathetic Nerve ◽

Ischemic Cardiomyopathy ◽

Sympathetic Nerve Activity ◽

Left Ventricular ◽

Isosorbide Mononitrate ◽

Cardiac Sympathetic Nerve ◽

Nerve Activity ◽

Cardiac Sympathetic Nerve Activity

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Sympathetic responses induced by radiofrequency catheter ablation of atrial fibrillation

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00470.2018 ◽

2019 ◽

Vol 316 (3) ◽

pp. H476-H484 ◽

Cited By ~ 2

Author(s):

Jian Cui ◽

Mario D. Gonzalez ◽

Cheryl Blaha ◽

Ashley Hill ◽

Lawrence I. Sinoway

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Sympathetic Nerve ◽

Radiofrequency Catheter Ablation ◽

Sympathetic Nerve Activity ◽

Muscle Sympathetic Nerve Activity ◽

Parasympathetic Activity ◽

Nerve Activity ◽

Cardiac Parasympathetic Activity

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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