Impact of cryoballoon-guided pulmonary vein isolation on non-invasive autonomic tests in patients with paroxysmal atrial fibrillation.

Autor:	Galloo X; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., Abugattas JP; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., Tijskens M; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium., Dendale P; Heart Center Hasselt and University Faculty of Medicine and Life Sciences, Hasselt, Belgium., Varnavas V; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., Wolf M; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium., De Cocker J; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium., Schwagten B; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., Sieira J; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., Ströker E; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., Chierchia GB; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., de Asmundis C; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium., De Greef Y; Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium; Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: yves.degreef@zna.be.
Jazyk:	angličtina
Zdroj:	Indian pacing and electrophysiology journal [Indian Pacing Electrophysiol J] 2019 Sep - Oct; Vol. 19 (5), pp. 171-177. Date of Electronic Publication: 2019 May 24.
DOI:	10.1016/j.ipej.2019.05.002
Abstrakt:	Background: Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system (ANS). We evaluated the impact of PVI on 5 non-invasive autonomic tests. Methods: Thirty patients (76% male, mean age 60.37 ± 9.02 years) with paroxysmal atrial fibrillation (AF) underwent cryoballoon-guided PVI. Five autonomic tests were performed 24hrs before and after PVI (N = 30) and repeated after 6months (N = 22). Parasympathetic function was measured by heart rate (HR) variability during deep breathing (E/I ratio, I-E difference), Valsalva maneuver (Valsalva-ratio) and head-up tilt test (30/15 ratio). Sympathetic function was measured by systolic BP response to sustained handgrip and 10' tilting and by diastolic BP response to cold water. Results: 24hrs after PVI, baseline HR increased from 57.93 ± 9.06 bpm to 71.10 ± 12.75 bpm (p < 0.001). At 6 months, baseline HR was lower than immediately post-PVI (62.59 ± 7.89 vs 71.36 ± 13.58 bpm, p = 0.032) but still higher in comparison to pre-PVI (62.59 ± 7.89 vs 57.09 ± 8.80 bpm, p < 0.001). No differences were seen in baseline BP and parasympathetic tests acutely and at 6months. Besides an acute lowering in systolic BP increase during handgrip test, all sympathetic tests remained unchanged. Conclusions: An acute HR increase attenuated at 6months and an acute lowered systolic BP response to sustained handgrip were the only changes after cryoballoon-guided PVI. Non-invasive autonomic tests seem therefore not appropriate to evaluate the autonomic modulatory effect of PVI, either due to a too limited sensitivity or a too localized effect of PVI to influence test results. (Copyright © 2019 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.)
Databáze:	MEDLINE
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