Ferreira Monica, Cunha Pedro Silva, Felix Ana Clara, Fonseca Helena, Oliveira Mario, Laranjo Sergio, Rocha Isabel
Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa-CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal.
Cardiology Department, Hospital de Santa Marta, Unidade Local de Saúde de S. José, 1150-199 Lisbon, Portugal.
J Clin Med. 2024 Sep 28;13(19):5796. doi: 10.3390/jcm13195796.
Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. : Seventy-eight patients with AF underwent CA and were followed up at one, three, and six months. Autonomic function was assessed using a combination of head-up tilt (HUT), handgrip (HG), and deep breathing (DB) manoeuvres along with baroreflex sensitivity (BRS) and baroreflex effectiveness index (BEI) evaluation. Heart rate (HR), blood pressure (BP), and their variability were measured at each time point. : Significant autonomic alterations were observed after ablation, particularly at one month, with reductions in parasympathetic tone and baroreflex function. These changes gradually normalised by six months. Both pulmonary vein isolation (PVI) and cryoablation (CryO) had similar effects on autonomic regulation. Improvements in quality of life, measured by the AFEQT scores, were consistent with these physiological changes. CA for AF induces significant time-dependent autonomic and haemodynamic changes with recovery over six months. These findings underscore the need for ongoing monitoring and personalised post-ablation management. Further research is required to explore the mechanisms driving these alterations and their long-term impacts on patient outcomes.
导管消融术(CA)是一种已被广泛认可的治疗心房颤动(AF)的方法。然而,其对自主神经功能的影响及潜在机制仍知之甚少。本研究调查了CA术后自主神经和血流动力学的变化,并探讨了它们对患者预后的潜在影响。78例AF患者接受了CA治疗,并在1个月、3个月和6个月进行随访。通过结合头高位倾斜试验(HUT)、握力试验(HG)和深呼吸试验(DB)以及压力反射敏感性(BRS)和压力反射有效性指数(BEI)评估来评估自主神经功能。在每个时间点测量心率(HR)、血压(BP)及其变异性。消融术后观察到明显的自主神经改变,尤其是在1个月时,副交感神经张力和压力反射功能降低。这些变化在6个月时逐渐恢复正常。肺静脉隔离术(PVI)和冷冻消融术(CryO)对自主神经调节的影响相似。通过AFEQT评分衡量的生活质量改善与这些生理变化一致。AF的CA治疗会引起明显的时间依赖性自主神经和血流动力学变化,并在6个月内恢复。这些发现强调了持续监测和个性化消融后管理的必要性。需要进一步研究以探索驱动这些改变的机制及其对患者预后的长期影响。