Kuyumcu Mevlut Serdar, Ozeke Ozcan, Cay Serkan, Ozcan Fırat, Bayraktar Muhammed Fatih, Kara Meryem, Vicdan Murat, Acar Burak, Aydogdu Sinan, Topaloglu Serkan, Aras Dursun
Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey.
Pacing Clin Electrophysiol. 2017 Nov;40(11):1193-1199. doi: 10.1111/pace.13179. Epub 2017 Oct 6.
The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices.
A total of 45 patients were enrolled with symptomatic, drug refractory paroxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge.
The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence.
This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.
自主神经系统（ANS）可能是心房颤动（AF）起始和持续的有力调节因子，而AF的存在可激活并改变ANS。AF导管消融术（AFCA）可能导致心脏ANS功能障碍，而AFCA恢复窦性心律或交感迷走神经失衡可逆转这一过程。我们的主要目标是研究AFCA对通过无创变时性（CI）、静息心率（RHR）和心率恢复（HRR）指标评估的ANS功能的短期影响。
共纳入45例有症状、药物难治性阵发性AF患者，采用单个28毫米冷冻球囊（CB），运用单次3分钟冷冻技术（无额外应用）进行首次冷冻球囊肺静脉前庭隔离（PVAI）。所有患者在PVAI前均接受症状限制运动平板试验以评估ANS的无创参数。对于仍维持窦性心律的患者，出院后1个月和3个月重复进行额外的运动试验。
PVAI后自主CI和RHR/HRR指标受损，并在PVAI后3个月持续存在。然而，有无复发患者的这些参数并无差异。
本研究表明，成功的AFCA可能同时损害ANS参数。AFCA后交感和副交感神经活动之间的自主失衡可能根据成功的AFCA后哪一种成分占优势而成为抗心律失常和/或促心律失常的因素。PVAI后ANS平衡受损也可能是AF复发的另一种假设机制，尤其是在无肺静脉重新连接的情况下。
