Toyoda Natsumi, Yoshiyama Tomotaka, Wakasa Shiho, Hirayama Shun, Fukuda Kohei, Yanagishita Tomoya, Shibata Atsushi, Fukuda Daiju
Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1 - 4- 3 Asahimachi, Abeno-ku, Osaka, 545 - 8585, Japan.
Heart Vessels. 2025 Apr 6. doi: 10.1007/s00380-025-02543-5.
Autonomic nervous system (ANS) modulation increases the heart rate (HR) after catheter ablation (CA) for paroxysmal atrial fibrillation (PAF). However, its influence on exercise tolerance (ET) is poorly understood. This single-center retrospective cohort study enrolled patients who underwent CA for PAF. To analyze the effects of ANS modulation on ET, cardiopulmonary stress testing was performed before and 3 and 12 months after CA. The final analysis included 25 patients in the cryoballoon ablation (CBA) group and 24 in the radiofrequency CA (RFCA) group. HR increased at 3 and 12 months after CA compared with preoperative values (64.8 ± 8.6 vs. 77.7 ± 10.9, p < 0.001; 64.8 ± 8.6 vs. 74.8 ± 11.4, p < 0.001). ANS modulation was more frequent in the CBA group than in the RFCA group at 3 and 12 months after CA (64% vs. 21%, p < 0.01; 48% vs. 4%, p < 0.01). However, no significant difference in ET was observed before and after CA (anaerobic threshold 15.2 ± 2.8 vs. 15.7 ± 2.8, p = 0.46; 15.4 ± 3.0 vs. 16.3 ± 3.9, p = 0.38; peak VO2 23.5 ± 5.7 vs. 24.4 ± 5.2, p = 0.44; 23.0 ± 6.0 vs. 25.3 ± 7.7; p = 0.43) at both 3 and 12 months after CA. ANS modulation was more frequently observed in the CBA group than in the RFCA group. ET was not worsened by ANS modulation after CA.
自主神经系统（ANS）调节可使阵发性心房颤动（PAF）导管消融（CA）术后心率（HR）增加。然而，其对运动耐量（ET）的影响尚不清楚。这项单中心回顾性队列研究纳入了接受PAF-CA的患者。为分析ANS调节对ET的影响，在CA术前、术后3个月和12个月进行了心肺应激试验。最终分析纳入了25例冷冻球囊消融（CBA）组患者和24例射频CA（RFCA）组患者。与术前值相比，CA术后3个月和12个月时HR增加（64.8±8.6 vs. 77.7±10.9，p<0.001；64.8±8.6 vs. 74.8±11.4，p<0.001）。CA术后3个月和12个月时，CBA组ANS调节比RFCA组更频繁（64% vs. 21%，p<0.01；48% vs. 4%，p<0.01）。然而，CA术后3个月和12个月时，CA前后ET均未观察到显著差异（无氧阈值15.2±2.8 vs. 15.7±2.8，p = 0.46；15.4±3.0 vs. 16.3±3.9，p = 0.38；峰值VO2 23.5±5.7 vs. 24.4±5.2，p = 0.44；23.0±6.0 vs. 25.3±7.7；p = 0.43）。CBA组比RFCA组更频繁观察到ANS调节。CA术后ANS调节未使ET恶化。
