High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

Călburean, Paul-Adrian; Osório, Thiago Guimarães; Sieira, Juan; Ströker, Erwin; Maj, Riccardo; Terasawa, Muryo; Rizzo, Alessandro; Borio, Gianluca; Scala, Oriana; Galli, A.; Brugada, Pedro; Chierchia, Gian‐Battista; Asmundis, Carlo de

doi:10.1007/s10840-019-00687-9

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…Our investigation used well‐established autonomic biomarkers that reflect diverse aspects of cardioneural function and suggest pleiotropic pathological effects of PTSD on autonomic dysfunction and CVD risk. DC HRV is an emerging, highly predictive autonomic biomarker of parasympathetic activity that measures the speed of short, low‐latency changes in heart rate (Călburean et al, 2021). The association of DC HRV reactivity with PTSDSS after the trauma reminder challenge suggests that parasympathetic withdrawal is an important physiological change accompanying symptomatic PTSD.…”

Section: Discussionmentioning

confidence: 99%

Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co‐twin control study

et al. 2022

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Post‐traumatic stress disorder (PTSD) has been associated with cardiovascular disease (CVD), but the mechanisms remain unclear. Autonomic dysfunction, associated with higher CVD risk, may be triggered by acute PTSD symptoms. We hypothesized that a laboratory‐based trauma reminder challenge, which induces acute PTSD symptoms, provokes autonomic dysfunction in a cohort of veteran twins. We investigated PTSD‐associated real‐time physiologic changes with a simulation of traumatic experiences in which the twins listened to audio recordings of a one‐minute neutral script followed by a one‐minute trauma script. We examined two heart rate variability metrics: deceleration capacity (DC) and logarithmic low frequency (log‐LF) power from beat‐to‐beat intervals extracted from ambulatory electrocardiograms. We assessed longitudinal PTSD status with a structured clinical interview and the severity with the PTSD Symptoms Scale. We used linear mixed‐effects models to examine twin dyads and account for cardiovascular and behavioral risk factors. We examined 238 male Veteran twins (age 68 ± 3 years old, 4% black). PTSD status and acute PTSD symptom severity were not associated with DC or log‐LF measured during the neutral session, but were significantly associated with lower DC and log‐LF during the traumatic script listening session. Long‐standing PTSD was associated with a 0.38 (95% confidence interval, −0.83,‐0.08) and 0.79 (−1.30,‐0.29) standardized unit lower DC and log‐LF, respectively, compared to no history of PTSD. Traumatic reminders in patients with PTSD lead to real‐time autonomic dysregulation and suggest a potential causal mechanism for increased CVD risk, based on the well‐known relationships between autonomic dysfunction and CVD mortality.

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Section: Discussionmentioning

confidence: 99%

Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co‐twin control study

et al. 2022

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“…16 Moreover, Chen et al showed that parasympathetic nervous system tonus as assessed by DC was higher in patients with AF recurrence after radiofrequency isolation of the PVs, 3 while we showed in a previous study that DC was also higher in patients with AF recurrence after CB isolation of the PVs. 17 Interestingly, HRV parameters did not differ after irrigated-tip RF ablation, contact-force sensing-guided RF ablation, or second-generation CB ablation, while higher vagal tone was associated with AF recurrence. 18 However, the association between ANS and PVs reconnection was not studied yet.…”

Section: Rationale Behind Association Of High Parasympathetic Tone and Pvs Reconnectionmentioning

confidence: 85%

High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation

Călburean

Osório

Sorgente

et al. 2021

Pacing Clinical Electrophis

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Background: Pulmonary vein (PV) isolation is an established treatment for paroxysmal drug-refractory atrial fibrillation (AF). High parasympathetic tone and reconnection of PVs have demonstrated to be possible culprits of AF recurrence after ablation.Our aim was to investigate the association between parasympathetic tone and reconnected PVs in patients with paroxysmal AF. Methods:Consecutive patients who underwent a redo catheter ablation procedure for atrial tachyarrhythmia recurrence by means of 3D electroanatomic mapping with documentation of presence or absence of PVs reconnection following an initial procedure of cryoballoon (CB) ablation for symptomatic drug-refractory paroxysmal AF were screened for the study.Results: A total of 92 patients were included, of whom 50 (54.35%) were males. Reconnected PVs were found in 64 (69%) patients. PVs reconnection could be predicted by DC (C-statistic = .770), by SDNNI (C-statistic = .714) and by absolute VLF power (C-statistic = .722), while right-sided PVs reconnection could be better predicted by DC (C-statistic = .848) and by SDNNI (C-statistic = .761). In multivariate binary logistic regression analysis, a DC value ≥6.45 ms and an absolute VLF power value ≥160 ms 2 were associated with three times and five times higher odds of PVs reconnection, respectively. On a vein-per-vein analysis, absolute VLF power ≥160 ms 2 was associated with three times higher odds, while reaching of −40 • C within 60 s was associated with three times lower odds of PVs reconnection. Conclusion:High parasympathetic tonus accurately predicts PVs reconnection. On a vein-per-vein analysis, parasympathetic markers along with biophysical parameters predicted PVs reconnection. On a case-by-case analysis, parasympathetic markers

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“…67 Another key clue of this role is the fact that therapies which blunt components of the autonomic nervous system suppresses AF in both animal and human studies. [68][69][70][71][72][73][74]…”

Section: Autonomic Tone Ganglionated Plexi and Atrial Fibrillationmentioning

confidence: 99%

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Aksu

Skeete

Huang

2023

Arrhythm Electrophysiol Rev

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As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS – ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation – constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.

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High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

Cited by 12 publications

References 29 publications

Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co‐twin control study

Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co‐twin control study

High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

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