Impact of cryoballoon-guided pulmonary vein isolation on non-invasive autonomic tests in patients with paroxysmal atrial fibrillation.
Autonomic function
Autonomic testing
Cryoballoon
Pulmonary vein isolation
Journal
Indian pacing and electrophysiology journal
ISSN: 0972-6292
Titre abrégé: Indian Pacing Electrophysiol J
Pays: Netherlands
ID NLM: 101157207
Informations de publication
Date de publication:
Historique:
received:
15
04
2019
accepted:
23
05
2019
pubmed:
28
5
2019
medline:
28
5
2019
entrez:
28
5
2019
Statut:
ppublish
Résumé
Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system (ANS). We evaluated the impact of PVI on 5 non-invasive autonomic tests. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 31132410
pii: S0972-6292(19)30078-6
doi: 10.1016/j.ipej.2019.05.002
pmc: PMC6823709
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
171-177Informations de copyright
Copyright © 2019 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.
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