Malik Varun, Elliott Adrian D, Thomas Gijo, Pitman Bradley, Fitzgerald John L, Young Glenn D, Arnolda Leonard F, Lau Dennis H, Sanders Prashanthan
Centre for Heart Rhythm Disorders University of Adelaide and Royal Adelaide Hospital Adelaide South Australia Australia.
J Arrhythm. 2025 Jun 23;41(3):e70119. doi: 10.1002/joa3.70119. eCollection 2025 Jun.
Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation. We previously demonstrated abnormal cardiac volume-sensitive reflexes (whose receptors are co-located in veno-atrial tissue) in AF patients. Whether PVI disrupts afferent nerves is unknown.
Evaluate whether PVI disrupts afferent volume-sensitive reflexes.
We consecutively studied autonomic reflexes in AF patients undergoing PVI, repeating the study post-PVI, if AF-free >6 months. We excluded patients with AF recurrence/procedural complications, allowing repeat procedures. We measured beat-to-beat mean arterial pressure (MAP) and heart rate (HR) continuously during low-level Lower Body Negative Pressure (LBNP), at 0, -20 and -40 mmHg (predominantly testing volume baroreceptors); Valsalva reflex (predominantly arterial baroreceptors); and Isometric Handgrip reflex (IHR, both). LBNP produces reflex vasoconstriction, evaluated from forearm blood flow (FBF ∝ 1/vascular resistance).
18 patients were studied pre-PVI; = 9 completed both visits. Mean age was 64 ± 3 years (78% male); BMI 28 ± 1 kg/m; LA size 37 ± 2 mL/m; and left ventricular function 65 ± 3%. Despite alterations in heart rate variability (HRV), there was no difference in IHR, Valsalva, or LBNP responses pre- versus post-PVI. During LBNP, MAP decreased slightly both pre- (-1.6 ± 3%) and post-PVI (-2.8 ± 1.8%); = .7. HR increased similarly ( = .7) pre- (10.6 ± 6.4%) and post-PVI (7.2 ± 1.5%). FBF response was unchanged ( = .8). Resting (arterial) baroreflex sensitivity was unaltered.
PVI does not impair cardiovascular reflexes involving afferent baroreceptors, suggesting HRV changes reflect efferent modulation or ablation adequacy rather than afferent disruption. Whether disrupting sino-atrial efferent nerves represents a marker of adequate ablation or influences PVI outcomes requires evaluation.
肺静脉隔离（PVI）仍然是心房颤动（AF）消融的基石。我们之前在AF患者中证明了异常的心腔容量敏感反射（其感受器共位于静脉心房组织中）。PVI是否会破坏传入神经尚不清楚。
评估PVI是否会破坏传入的容量敏感反射。
我们连续研究了接受PVI的AF患者的自主反射，如果无AF超过6个月，则在PVI后重复该研究。我们排除了AF复发/手术并发症患者，允许重复手术。在低水平下体负压（LBNP）期间，我们连续测量逐搏平均动脉压（MAP）和心率（HR），分别为0、-20和-40 mmHg（主要测试容量压力感受器）；瓦尔萨尔瓦反射（主要是动脉压力感受器）；以及等长握力反射（IHR，两者皆有）。LBNP会产生反射性血管收缩，通过前臂血流量（FBF ∝ 1/血管阻力）进行评估。
18例患者在PVI前进行了研究；9例完成了两次检查。平均年龄为64±3岁（78%为男性）；体重指数28±1 kg/m；左心房大小37±2 mL/m；左心室功能65±3%。尽管心率变异性（HRV）有所改变，但PVI前后的IHR、瓦尔萨尔瓦反射或LBNP反应没有差异。在LBNP期间，MAP在PVI前（-1.6±3%）和PVI后（-2.8±1.8%）均略有下降；P = 0.7。HR在PVI前（10.6±6.4%）和PVI后（7.2±1.5%）的增加相似（P = 0.7）。FBF反应未改变（P = 0.8）。静息（动脉）压力反射敏感性未改变。
PVI不会损害涉及传入压力感受器的心血管反射，提示HRV变化反映的是传出调制或消融充分性，而非传入中断。破坏窦房传出神经是否代表消融充分的标志或影响PVI结果需要评估。
