Ferreira Mónica, Laranjo Sérgio, Cunha Pedro, Geraldes Vera, Oliveira Mário, Rocha Isabel
Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa-CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal.
Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central-CHULC, 1150-199 Lisbon, Portugal.
J Clin Med. 2023 Sep 8;12(18):5857. doi: 10.3390/jcm12185857.
The abnormal neural control of atria has been considered one of the mechanisms of paroxysmal atrial fibrillation (PAF) pathogenesis. The baroreceptor reflex has an important role in cardiovascular regulation and may serve as an index of autonomic function. This study aimed to analyze the baroreceptor reflex's role in heart rate regulation during upright tilt (HUT) in patients with lone PAF. The study included 68 patients with lone PAF and 34 healthy individuals who underwent baroreflex assessment. Parameters such as baroreflex sensitivity (BRS), number of systolic blood pressure (BP) ramps, and the baroreflex effectiveness index (BEI) were evaluated. The study found that PAF patients had comparable resting BPs and heart rates (HRs) to healthy individuals. However, unlike healthy individuals, PAF patients showed a sustained increase in BP with an upright posture followed by the delayed activation of the baroreceptor function with a blunted HR response and lower BEI values. This indicates a pronounced baroreflex impairment in PAF patients, even at rest. Our data suggest that together with BRS, BEI could be used as a marker of autonomic dysfunction in PAF patients, making it important to further investigate its relationship with AF recurrence after ablation and its involvement in cardiovascular autonomic remodeling.
心房的异常神经控制被认为是阵发性心房颤动（PAF）发病机制之一。压力感受器反射在心血管调节中起重要作用，可作为自主神经功能的指标。本研究旨在分析压力感受器反射在孤立性PAF患者直立倾斜试验（HUT）期间心率调节中的作用。该研究纳入了68例孤立性PAF患者和34例接受压力反射评估的健康个体。评估了压力反射敏感性（BRS）、收缩压（BP）斜坡数量和压力反射有效性指数（BEI）等参数。研究发现，PAF患者的静息血压和心率与健康个体相当。然而，与健康个体不同的是，PAF患者在直立姿势时血压持续升高，随后压力感受器功能延迟激活，心率反应迟钝，BEI值较低。这表明即使在静息状态下，PAF患者也存在明显的压力反射受损。我们的数据表明，与BRS一起，BEI可作为PAF患者自主神经功能障碍的标志物，因此进一步研究其与消融术后房颤复发的关系及其在心血管自主神经重塑中的作用具有重要意义。
