Effect of pulmonary vein isolation on the relationship between left atrial reverse remodeling and sympathetic nerve activity in patients with atrial fibrillation
Effect of pulmonary vein isolation on the relationship between left atrial reverse remodeling and sympathetic nerve activity in patients with atrial fibrillation
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DOI：
10.1007/s10286-022-00873-2
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发表时间：
2022-06-23
影响因子：
5.8
通讯作者：
Takamura, Masayuki
中科院分区：
文献类型：
--
作者：
Mukai, Yusuke;Murai, Hisayoshi;Takamura, Masayuki
目的 隔离肺静脉的导管消融 (CA) 是房颤 (AF) 的既定治疗方法，与左心房逆重构 (LARR) 相关。内在的心脏自主神经系统包括左心房 (LA) 中与肺静脉相邻的神经节丛。然而，关于CA对AF患者LARR与交感神经活动关系的影响知之甚少。方法 本研究纳入了 22 名左心室射血分数 (LVEF) 正常、年龄为 64.6 +/- 12.9 岁、计划接受 CA 的 AF 患者。通过直接记录 CA 前和 CA 后 12 周的肌肉交感神经活动 (MSNA) 来评估交感神经活动。还测量了血压、心率 (HR)、HR 变异性和超声心动图。结果 CA 后心率显着增加（63 +/- 10.9 次/分钟 vs. 70.6 +/- 7.7 次/分钟，p < 0.01），但血压没有变化。消融后心率变异性的高频（HF）和低频（LF）显着降低，但 LF/HF 没有观察到显着变化。 CA 显着降低 MSNA（38.9 +/- 9.9 对比 28 +/- 9.1 爆发/分钟，p < 0.01）。此外，回归分析显示 MSNA 的百分比变化与 LA 体积指数之间呈正相关（r = 0.442，p < 0.05）。结论 我们的结果表明，CA 治疗 AF 可降低 MSNA，并且这种降低与 LVEF 正常的 AF 患者的 LA 体积指数相关。这些发现表明 CA 诱导的 LARR 会降低 AF 的交感神经活动。
Purpose Catheter ablation (CA) to isolate the pulmonary vein, which is an established treatment for atrial fibrillation (AF), is associated with left atrium reverse remodeling (LARR). The intrinsic cardiac autonomic nervous system includes the ganglion plexi adjacent to the pulmonary vein in the left atrium (LA). However, little is known about the effect of CA on the relationship between LARR and sympathetic nerve activity in patients with AF. Methods This study enrolled 22 AF patients with a normal left ventricular ejection fraction (LVEF) aged 64.6 +/- 12.9 years who were scheduled for CA. Sympathetic nerve activity was evaluated by direct recording of muscle sympathetic nerve activity (MSNA) before and 12 weeks after CA. Blood pressure, heart rate (HR), HR variability, and echocardiography were also measured. Results The heart rate increased significantly after CA (63 +/- 10.9 vs. 70.6 +/- 7.7 beats/min, p < 0.01), but blood pressure did not change. A high frequency (HF) and low frequency (LF) of HR variability decreased significantly after ablation, but no significant change in LF/HF was observed. CA significantly decreased MSNA (38.9 +/- 9.9 vs. 28 +/- 9.1 bursts/min, p < 0.01). Moreover, regression analysis revealed a positive correlation between the percentage change in MSNA and the LA volume index (r = 0.442, p < 0.05). Conclusions Our results show that CA for AF reduced MSNA and the decrease was associated with the LA volume index in AF patients with a normal LVEF. These findings suggest that LARR induced by CA for AF decrease sympathetic nerve activity.