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Title: | Impact of cryoballoon-guided pulmonary vein isolation on non-invasive autonomic tests in patients with paroxysmal atrial fibrillation. | Authors: | Galloo, Xavier Abugattas, Juan-Pablo Tijskens, Maxime DENDALE, Paul Varnavas, Varnavas Wolf, Michael Do Cocker, Jeroen Schwagten, Bruno Sieira, Juan Ströker, Erwin Chierchia, Gian-Battista de Asmundis, Carlo De Greef, Yves |
Issue Date: | 2019 | Source: | Indian Pacing and Electrophysiology Journal, 19(5), p. 171-177. | Abstract: | 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 ¼ 30) and repeated after 6months (N ¼ 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 ¼ 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 | Keywords: | Pulmonary vein isolation;Cryoballoon;Autonomic function;Autonomic testing | Document URI: | http://hdl.handle.net/1942/29582 | ISSN: | 0972-6292 | DOI: | 10.1016/j.ipej.2019.05.002 | Rights: | 2019, Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license | Category: | A1 | Type: | Journal Contribution | Validations: | vabb 2021 |
Appears in Collections: | Research publications |
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