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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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Abstract

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.

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References

  1. Benjamin EJ, Wolf PA, D’Agostino RB et al (1998) Impact of atrial fibrillation on the risk of death: the Framingham heart study. Circulation 98:946–952. https://doi.org/10.1161/01.CIR.98.10.946

    Article  CAS  PubMed  Google Scholar 

  2. Wasmund SL, Li JM, Page RL et al (2003) Effect of atrial fibrillation and an irregular ventricular response on sympathetic nerve activity in human subjects. Circulation 107:2011–2015. https://doi.org/10.1161/01.CIR.0000064900.76674.CC

    Article  PubMed  Google Scholar 

  3. Ikeda T, Murai H, Kaneko S et al (2012) Augmented single-unit muscle sympathetic nerve activity in heart failure with chronic atrial fibrillation. J Physiol 590:509–518. https://doi.org/10.1113/jphysiol.2011.223842

    Article  CAS  PubMed  Google Scholar 

  4. Po SS, Nakagawa H, Jackman WM (2009) Localization of left atrial ganglionated plexi in patients with atrial fibrillation. J Cardiovasc Electrophysiol 20:1186–1189. https://doi.org/10.1111/j.1540-8167.2009.01515.x

    Article  PubMed  Google Scholar 

  5. Wake E, Brack K (2016) Characterization of the intrinsic cardiac nervous system. Auton Neurosci Basic Clin 199:3–16. https://doi.org/10.1016/j.autneu.2016.08.006

    Article  Google Scholar 

  6. Morita N, Iida T, Nanao T et al (2021) Effect of ganglionated plexi ablation by high-density mapping on long-term suppression of paroxysmal atrial fibrillation – the first clinical survey on ablation of the dorsal right plexus. Hear Rhythm O2(2):480–488. https://doi.org/10.1016/j.hroo.2021.07.002

    Article  Google Scholar 

  7. Folkow B (2000) Perspectives on the integrative functions of the “sympatho-adrenomedullary system.” Auton Neurosci 83:101–115. https://doi.org/10.1016/S1566-0702(00)00171-5

    Article  CAS  PubMed  Google Scholar 

  8. Weisbrod CJ, Arnolda LF, McKitrick DJ et al (2004) Vasomotor responses to decreased venous return: effects of cardiac deafferentation in humans. J Physiol 560:919–927. https://doi.org/10.1113/jphysiol.2004.069732

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Malik V, Elliott AD, Thomas G et al (2022) Autonomic afferent dysregulation in atrial fibrillation. JACC Clin Electrophysiol 8:152–164. https://doi.org/10.1016/j.jacep.2021.10.010

    Article  PubMed  Google Scholar 

  10. Reant P, Lafitte S, Jaïs P et al (2005) Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation. Circulation 112:2896–2903. https://doi.org/10.1161/CIRCULATIONAHA.104.523928

    Article  PubMed  Google Scholar 

  11. Kagawa Y, Fujii E, Fujita S, Ito M (2020) Association between left atrial reverse remodeling and maintenance of sinus rhythm after catheter ablation of persistent atrial fibrillation. Heart Vessels 35:239–245. https://doi.org/10.1007/s00380-019-01475-1

    Article  PubMed  Google Scholar 

  12. Oka T, Inoue K, Tanaka K et al (2018) Left atrial reverse remodeling after catheter ablation of nonparoxysmal atrial fibrillation in patients with heart failure with reduced ejection fraction. Am J Cardiol 122:89–96. https://doi.org/10.1016/j.amjcard.2018.03.026

    Article  PubMed  Google Scholar 

  13. Masuda M, Yamada T, Mizuno H et al (2015) Impact of atrial fibrillation ablation on cardiac sympathetic nervous system in patients with and without heart failure. Int J Cardiol 199:65–70. https://doi.org/10.1016/j.ijcard.2015.07.028

    Article  PubMed  Google Scholar 

  14. Marinković M, Mujović N, Vučićević V et al (2020) A square root pattern of changes in heart rate variability during the first year after circumferential pulmonary vein isolation for paroxysmal atrial fibrillation and their relation with long-term arrhythmia recurrence. Kardiol Pol 78:209–218. https://doi.org/10.33963/KP.15187

    Article  PubMed  Google Scholar 

  15. Nogami A, Kurita T, Abe H et al (2021) JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythmia 37:709–870. https://doi.org/10.1002/joa3.12491

    Article  Google Scholar 

  16. Murai H, Takamura M, Maruyama M et al (2009) Altered firing pattern of single-unit muscle sympathetic nerve activity during handgrip exercise in chronic heart failure. J Physiol 587:2613–2622. https://doi.org/10.1113/jphysiol.2009.172627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hamaoka T, Murai H, Hirai T et al (2021) Different responses of muscle sympathetic nerve activity to dapagliflozin between patients with type 2 diabetes with and without heart failure. J Am Heart Assoc 10:1–12. https://doi.org/10.1161/jaha.121.022637

    Article  CAS  Google Scholar 

  18. Hamaoka T, Murai H, Kaneko S et al (2016) Single-unit muscle sympathetic nerve activity reflects sleep apnea severity, especially in severe obstructive sleep apnea patients. Front Physiol 7:1–9. https://doi.org/10.3389/fphys.2016.00066

    Article  Google Scholar 

  19. Fagius J, Wallin BG (1993) Long-term variability and reproducibility of resting human muscle nerve sympathetic activity at rest, as reassessed after a decade. Clin Auton Res 3:201–205

    Article  CAS  Google Scholar 

  20. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  21. Kim M-Y, Coyle C, Tomlinson DR et al (2021) Ectopy-triggering ganglionated plexuses ablation to prevent atrial fibrillation: GANGLIA-AF study. Hear Rhythm. https://doi.org/10.1016/j.hrthm.2021.12.010

    Article  Google Scholar 

  22. Cui J, Gonzalez MD, Blaha C et al (2019) Sympathetic responses induced by radiofrequency catheter ablation of atrial fibrillation. Am J Physiol - Hear Circ Physiol 316:H476–H484. https://doi.org/10.1152/ajpheart.00470.2018

    Article  CAS  Google Scholar 

  23. Tops LF, Bax JJ, Zeppenfeld K et al (2006) Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. Am J Cardiol 97:1220–1222. https://doi.org/10.1016/j.amjcard.2005.11.043

    Article  PubMed  Google Scholar 

  24. Tops LF, Delgado V, Bertini M et al (2011) Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol 57:324–331. https://doi.org/10.1016/j.jacc.2010.05.063

    Article  PubMed  Google Scholar 

  25. Millar PJ, Murai H, Floras JS (2015) Paradoxical muscle sympathetic reflex activation in human heart failure. Circulation 131:459–468. https://doi.org/10.1161/CIRCULATIONAHA.114.010765

    Article  PubMed  Google Scholar 

  26. Marrouche NF, Brachmann J, Andresen D et al (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378:417–427. https://doi.org/10.1056/nejmoa1707855

    Article  PubMed  Google Scholar 

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Funding

H.M. was supported by JSPS KAKENHI Grant Number 26350497.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences Kanazawa, Kanazawa, Japan

    Yusuke Mukai, Hisayoshi Murai, Takuto Hamaoka, Hiroyuki Sugimoto, Oto Inoue, Chiaki Goten, Takashi Kusayama, Shin-ichiro Takashima, Takeshi Kato, Soichiro Usui, Kenji Sakata & Masayuki Takamura

  2. Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan

    Hisayoshi Murai & Shigeo Takata

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  1. Yusuke Mukai
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Correspondence to Hisayoshi Murai.

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Mukai, Y., Murai, H., Hamaoka, T. et al. Effect of pulmonary vein isolation on the relationship between left atrial reverse remodeling and sympathetic nerve activity in patients with atrial fibrillation. Clin Auton Res 32, 229–235 (2022). https://doi.org/10.1007/s10286-022-00873-2

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  • DOI: https://doi.org/10.1007/s10286-022-00873-2

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