The value of cardiac sympathetic nervous system activity in the prognosis of atrial fibrillation radiofrequency ablation

Autor: Y.U.V Varlamova, S.I Sazonova, K. V. Zavadovsky, I V Kisteneva
Rok vydání: 2020
Předmět:
Zdroj: European Heart Journal. 41
ISSN: 1522-9645
0195-668X
DOI: 10.1093/ehjci/ehaa946.0306
Popis: Background Atrial fibrillation (AF) is one of the widest spread forms of arrhythmia worldwide. To date, radiofrequency catheter ablation (RFCA) of AF is a valuable treatment option. So far there are no clear predictors of the effectiveness of AF ablation. Nowadays, the association of cardiac sympathetic nervous system and the development and maintenance of AF has been showed. However, the association between sympathetic innervation disturbances and AF RFCA effectiveness remains inconclusive. Purpose To study the prognostic significance of cardiac sympathetic activity assessed by 123I-MIBG scintigraphy in AF RFCA efficacy. Methods The study included 46 patients. All patients were divided into 3 groups: I group - persistent AF (n=20), II group - long-standing persistent AF (LSPAF) (n=16), III group - sinus rhythm patients (n=10). All patients underwent 123I-MIBG and 99mTc-MIBI scintigraphy (planar and SPECT) to evaluate the cardiac sympathetic activity and myocardial perfusion, respectively. Echocardiography was performed in all patients to assess the cardiac contractile function. The effectiveness of interventional treatment was assessed in one year by 24 hour Holter monitoring. Results During a median follow-up of 12±6 month, arrhythmia recurrence was observed in 7 (35%) PAF patients and in 8 (50%) LSPAF patients. The univariate regression analysis showed that in patients with PAF the left atrial diameter (LAD), 123I-MIBG washout rate (WR), delayed 123I-MIBG defect score, and 123I-mIBG/99mTc-MIBI mismatch score were predictors of AF recurrence. In this group only the WR was a multivariate predictor of AF recurrence (odds ratios: 1.668, 95% confidence interval: 1.093–2.548, p=0.018). The receiver operator characteristics curve (ROC) analysis indicated the potential diagnostic value of WR to predict recurrence of AF after RFCA in PAF patients with an area under the curve of 0.968 (P Conclusions In AF patients the incidence of arrhythmia recurrence after RFCA is associated with impaired sympathetic nervous activity. The prognosis of AF recurrence in LSPAF patients has a link with rest myocardial perfusion disturbances which may reflect the severer structural change of myocardium. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Russian Science Foundation
Databáze: OpenAIRE
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