Long-Term Differences in Autonomic Alterations After Cryoballoon vs Radiofrequency Atrial Fibrillation Ablation.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2024-10-16 DOI:10.1016/j.jacep.2024.09.003

Jason G Andrade, Richard G Bennett, Marc W Deyell, Matthew T Bennett, Jobanjit Phulka, Nathaniel M Hawkins, Tolga Aksu, Thalia S Field, Martin Aguilar, Paul Khairy, Laurent Macle

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Abstract

Background: The long-term natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined.

Objectives: The authors sought to define the long-term impact of thermal catheter ablation on the cardiac autonomic system.

Methods: The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using thermal ablation energy (radiofrequency or cryoballoon ablation). All patients underwent insertion of a Reveal LINQ implantable cardiac monitor prior to ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (HRV) (measured as the standard deviation of the average normal-to-normal), daytime heart rate, and nighttime heart rate (NHR). Longitudinal autonomic data in the 2-month period prior to the date of ablation were compared with the 3 years following ablation.

Results: Following ablation, there was a significant decrease in HRV (10-20 ms; P < 0.0001) and significant increases in daytime heart rate and NHR (10 beats/min [P < 0.0001] and 7 beats/min [P < 0.0001], respectively). Changes in autonomic parameters were greatest in the first 3 months following ablation but remained significantly different from baseline for 36 months following ablation. Greater changes in NHR and HRV were associated with improved freedom from recurrent arrhythmia. The type of thermal ablation energy had no influence on the heart rate and autonomic parameters.

Conclusions: Pulmonary vein isolation using thermal ablation energy results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are independent of the ablation technology employed and are associated with procedural success. (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Duration [CIRCA-DOSE]; NCT01913522).

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冷冻球囊与射频心房颤动消融术后自主神经变化的长期差异。

背景：药物难治性阵发性心房颤动导管消融术后自主神经改变的长期自然史尚不明确：作者试图确定热导管消融术对心脏自律神经系统的长期影响：研究纳入了346名药物难治性阵发性心房颤动患者，他们都接受了使用热消融能量（射频或冷冻球囊消融）的肺静脉隔离治疗。所有患者都在消融术前植入了 Reveal LINQ 植入式心脏监护仪。植入式心脏监护仪可连续记录体力活动、心率变异性（HRV）（以正常与正常平均值的标准偏差测量）、日间心率和夜间心率（NHR）。将消融术前 2 个月的纵向自律神经数据与消融术后 3 年的数据进行了比较：消融术后，心率变异显著降低（10-20 毫秒；P < 0.0001），日间心率和夜间心率显著增加（分别为 10 次/分钟 [P < 0.0001] 和 7 次/分钟 [P < 0.0001]）。自律神经参数的变化在消融术后的头 3 个月最大，但在消融术后的 36 个月内与基线相比仍有显著差异。NHR和HRV的较大变化与心律失常复发率的改善有关。热消融能量的类型对心率和自律神经参数没有影响：结论：使用热消融能量进行肺静脉隔离会导致与自律神经功能相关的心率参数发生显著的持续变化。这些变化与所采用的消融技术无关，并与手术成功与否有关。(冷冻气球与灌注射频导管消融术：双短暴露持续时间与标准暴露持续时间[CIRCA-DOSE]；NCT01913522）。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.