vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2023-2-06TAXIUUvestar-1227Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESИзменение активности барорефлекса после изоляции легочных вен у пациентов с фибрилляцией предсердийBaroreflex activity change after pulmonary vein isolation in patients with atrial fibrillationhttps://orcid.org/0000-0003-1300-4986ГоревМ. В.GorevM. V.

Москва, ул. Бакунинская, д. 1-3

Moscow, 1-3 Bakuninskaya str.

DrGorevMV@gmail.comhttps://orcid.org/0000-0001-9921-1323НардаяШ. Г.NardaiaSh. G.

ул. Яузская, д.11

Moscow, 11 Yauzskaya str.

https://orcid.org/0000-0002-5767-6533ПетелькоС. В.PetelkoS. V.

ул. Яузская, д.11

Moscow, 11 Yauzskaya str.

https://orcid.org/0000-0003-4180-0445МакарычеваО. В.MakarychevaO. V.

ул. Яузская, д.11

Москва, ул. Делегатская, д. 20/1

Moscow, 11 Yauzskaya str.

20/1 Delegatskaya str.

ГайдуковаН. А.GaidukovaN. A.

ул. Яузская, д.11

Moscow, 11 Yauzskaya str.

https://orcid.org/0000-0001-6833-8938СергееваО. А.SergeevaO. A.

ул. Яузская, д.11

Moscow, 11 Yauzskaya str.

https://orcid.org/0000-0002-4094-7771РзаевФ. ГRzaevF. G.

ул. Яузская, д.11

Москва, ул. Делегатская, д. 20/1

Moscow, 11 Yauzskaya str.

20/1 Delegatskaya str.

АО Семейный докторРоссияAO Family ClinicRussian FederationГБУЗ города Москвы «Городская клиническая больница имени И.В.Давыдовского Департамента здравоохранения города Москвы»РоссияClinical City Hospital named after I.V. DavydovskyRussian FederationГБУЗ города Москвы «Городская клиническая больница имени И.В.Давыдовского Департамента здравоохранения города Москвы»; ФГБОУВО «Московский государственный медико-стоматологический университет имени А.И.Евдокимова» МЗ РФРоссияClinical City Hospital named after I.V. Davydovsky; Moscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian Federation2023270620233024450Copyright © Горев М.В., Нардая Ш.Г., Петелько С.В., Макарычева О.В., Гайдукова Н.А., Сергеева О.А., Рзаев Ф.Г., 20232023Горев М.В., Нардая Ш.Г., Петелько С.В., Макарычева О.В., Гайдукова Н.А., Сергеева О.А., Рзаев Ф.Г.Gorev M.V., Nardaia S.G., Petelko S.V., Makarycheva O.V., Gaidukova N.A., Sergeeva O.A., Rzaev F.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1227Цель

Цель. Целью данной работы явилось изучение интраоперационных изменений активности артериального барорефлекса, возникающих после катетерной изоляции легочных вен у пациентов с фибрилляцией предсердий.

Материал и методы исследования. C октября 2021 по июнь 2022 гг у 21 пациента с пароксизмальной фибрилляцией предсердий выполнена катетерная изоляция легочных вен на фоне синусового ритма. Всем пациентам до и после операции проведена оценка активности артериального барорефлекса с помощью пробы с фенилэфрином.

Результаты

Результаты. После катетерной изоляции легочных вен отмечено снижение активности барорефлекса по сравнению с предоперационными значениями с 5,8 [3,5; 11,3] мс/мм рт.ст. до 0,3 [-0,1; 1,8] мс/мм рт.ст., р<0,001 при расчете по систолическому артериальному давлению и с 9,5 [5,1; 15,5] до 0,6 [0; 7,6] мс/мм рт.ст., р=0,033, при расчете по диастолическому артериальному давлению.

Выводы

Выводы. У пациентов с пароксизмальной формой фибрилляции предсердий после катетерной изоляции легочных вен происходит снижение активности артериального барорефлекса.

Aim

Aim. To study the intraprocedural changes in baroreflex activity after catheter pulmonary vein isolation in paroxysmal atrial fibrillation patients.

Methods

Methods. From October 2021 to June 2022, sinus rhythm was registered at the start of procedure in 21 patients with paroxysmal atrial fibrillation admitted for catheter pulmonary vein isolation. Patients before and after procedure were tested with phenylephrine. Pre- and postoperative baroreflex activity and sinus rhythm rate were analyzed.

Results

Results. After catheter pulmonary vein isolation, the baroreflex activity decreased from 5.8 [3.5; 11.3] ms/mmHg to 0.3 [-0.1; 1.8] ms/mmHg, р<0.001, based on systolic arterial pressure, and from 9.5 [5.1; 15.5] ms/mmHg to 0.6 [0; 7.6] ms/mmHg, p=0.033, based on diastolic arterial pressure.

Conclusion

Conclusion. Intraprocedural phenylephrine test allows to study the baroreflex activity changes and to assess the modification of cardiac autonomic innervation.

изоляция легочных венфибрилляция предсердийвегетативная нервная системаартериальный барорефлексфенилэфринкатетерная аблациякардионейроаблацияpulmonary vein isolationatrial fibrillationautonomic nervous systemarterial baroreflexphenylephrinecatheter ablationcardioneuroablationисследование поддержано грантом Правительства Москвы на реализацию научно-практического проекта в медицине № 2212-12.the study was supported by a grant from the Government of Moscow for the implementation of a scientific and practical project in medicine No. 2212-12.ReferencesKetels S, Houben R, Van Beeumen K, Tavernier R, Duytschaever M. Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation. Europace. 2008;10(12): 1406-1414. https://doi.org/10.1093/europace/eun287.Ketels S, Houben R, Van Beeumen K, Tavernier R, Duytschaever M. Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation. Europace. 2008;10(12): 1406-1414. https://doi.org/10.1093/europace/eun287.Pappone C, Santinelli V, Manguso F, et al. Pulmonary Vein Denervation Enhances Long-Term Benefit after Circumferential Ablation for Paroxysmal Atrial Fibrillation. Circulation. 2004;109(3): 327-334. https://doi.org/10.1161/01.CIR.0000112641.16340.C7.Pappone C, Santinelli V, Manguso F, et al. Pulmonary Vein Denervation Enhances Long-Term Benefit after Circumferential Ablation for Paroxysmal Atrial Fibrillation. Circulation. 2004;109(3): 327-334. https://doi.org/10.1161/01.CIR.0000112641.16340.C7.Hou Y, Scherlag BJ, Lin J, et al. Interactive atrial neural network: Determining the connections between ganglionated plexi. Hear Rhythm. 2007;4(1): 56-63. https://doi.org/10.1016/j.hrthm.2006.09.020.Hou Y, Scherlag BJ, Lin J, et al. Interactive atrial neural network: Determining the connections between ganglionated plexi. Hear Rhythm. 2007;4(1): 56-63. https://doi.org/10.1016/j.hrthm.2006.09.020.Vanoli E, Adamson PB. Baroreflex Sensitivity : Methods , Mechanisms , and Prognostic Value. 1994;17(March): 434-446.Vanoli E, Adamson PB. Baroreflex Sensitivity : Methods , Mechanisms , and Prognostic Value. 1994;17(March): 434-446.Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity. Circ Res. 1969;24(1): 109-121. https://doi.org/10.1161/01.RES.24.1.109.Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity. Circ Res. 1969;24(1): 109-121. https://doi.org/10.1161/01.RES.24.1.109.Bristow JD, Honour AJ, Pickering GW, Sleight P, Smyth HS. Diminished baroreflex sensitivity in high blood pressure. Circulation. 1969;39(1): 48-54. https://doi.org/10.1161/01.CIR.39.1.48.Bristow JD, Honour AJ, Pickering GW, Sleight P, Smyth HS. Diminished baroreflex sensitivity in high blood pressure. Circulation. 1969;39(1): 48-54. https://doi.org/10.1161/01.CIR.39.1.48.Garcia R, Sosner P, Laude D, Hadjadj S, Herpin D, Ragot S. Spontaneous baroreflex sensitivity measured early after acute myocardial infarction is an independent predictor of cardiovascular mortality: Results from a 12-year follow-up study. Int J Cardiol. 2014;177(1): 120-122. https://doi.org/10.1016/j.ijcard.2014.09.100.Garcia R, Sosner P, Laude D, Hadjadj S, Herpin D, Ragot S. Spontaneous baroreflex sensitivity measured early after acute myocardial infarction is an independent predictor of cardiovascular mortality: Results from a 12-year follow-up study. Int J Cardiol. 2014;177(1): 120-122. https://doi.org/10.1016/j.ijcard.2014.09.100.Gouveia S, Scotto MG, Pinna GD, Maestri R, La Rovere MT, Ferreira PJSG. Spontaneous baroreceptor reflex sensitivity for risk stratification of heart failure patients: Optimal cut-offand age effects. Clin Sci. 2015;129(12): 1163-1172. https://doi.org/10.1042/CS20150341.Gouveia S, Scotto MG, Pinna GD, Maestri R, La Rovere MT, Ferreira PJSG. Spontaneous baroreceptor reflex sensitivity for risk stratification of heart failure patients: Optimal cut-offand age effects. Clin Sci. 2015;129(12): 1163-1172. https://doi.org/10.1042/CS20150341.Garcia R, Degand B, Fraty M, et al. Baroreflex sensitivity assessed with the sequence method is associated with ventricular arrhythmias in patients implanted with a defibrillator for the primary prevention of sudden cardiac death. Arch Cardiovasc Dis. 2019;112(4): 270-277. https://doi.org/10.1016/j.acvd.2018.11.009.Garcia R, Degand B, Fraty M, et al. Baroreflex sensitivity assessed with the sequence method is associated with ventricular arrhythmias in patients implanted with a defibrillator for the primary prevention of sudden cardiac death. Arch Cardiovasc Dis. 2019;112(4): 270-277. https://doi.org/10.1016/j.acvd.2018.11.009.Hocini M, Sanders P, Deisenhofer I, et al. Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses. Circulation. 2003;108(10): 1172-1175. https://doi.org/10.1161/01.CIR.0000090685.13169.07.Hocini M, Sanders P, Deisenhofer I, et al. Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses. Circulation. 2003;108(10): 1172-1175. https://doi.org/10.1161/01.CIR.0000090685.13169.07.Khaykin Y, Marrouche NF, Martin DO, et al. Pulmonary vein isolation for atrial fibrillation in patients with symptomatic sinus bradycardia or pauses. J Cardiovasc Electrophysiol. 2004;15(7): 784-789. https://doi.org/10.1046/j.1540-8167.2004.03279.x.Khaykin Y, Marrouche NF, Martin DO, et al. Pulmonary vein isolation for atrial fibrillation in patients with symptomatic sinus bradycardia or pauses. J Cardiovasc Electrophysiol. 2004;15(7): 784-789. https://doi.org/10.1046/j.1540-8167.2004.03279.x.Ревишвили АШ, Шляхто ЕВ, Попов СВ, и др. Клинические рекомендации по проведению электрофизиологических исследований, катетерной аблации и применению имплантированных антиаритмических устройств. Всероссийское научное общество специалистов по клинической электрофизиологии, аритмологии и кардиостимуляции (ВНОА). Новая редакция 2017. Москва. 2017, C.596.Revishvili ASh, Shliakhto EV, Popov SV, et al. Clinical guidelines for electrophysiological studies, catheter ablation and the use of implanted antiarrhythmic devices. All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Cardiac Stimulation (VNOA). New edition 2017. Moscow. 2017, P. 596 (In Russ.)].Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5): 373-498. https://doi.org/10.1093/eurheartj/ehaa612.Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5): 373-498. https://doi.org/10.1093/eurheartj/ehaa612.Katritsis DG, Giazitzoglou E, Zografos T, Pokushalov E, Po SS, Camm AJ. Rapid pulmonary vein isolation combined with autonomic ganglia modification: A randomized study. Hear Rhythm. 2011;8(5): 672-678. https://doi.org/10.1016/j.hrthm.2010.12.047.Katritsis DG, Giazitzoglou E, Zografos T, Pokushalov E, Po SS, Camm AJ. Rapid pulmonary vein isolation combined with autonomic ganglia modification: A randomized study. Hear Rhythm. 2011;8(5): 672-678. https://doi.org/10.1016/j.hrthm.2010.12.047.Gorev M V, Nardaia SG, Sergeeva OA. Long-term Success of Cardioneuroablation in a Patient with Tachy - Brady Syndrome and Syncope. 2021;12(October): 1-5. https://doi.org/10.19102/icrm.2021.121001.Gorev M V, Nardaia SG, Sergeeva OA. Long-term Success of Cardioneuroablation in a Patient with Tachy - Brady Syndrome and Syncope. 2021;12(October): 1-5. https://doi.org/10.19102/icrm.2021.121001.Mikhaylov E, Kanidieva A, Sviridova N, et al. Outcome of anatomic ganglionated plexi ablation to treat paroxysmal atrial fibrillation: A 3-year follow-up study. Europace. 2011;13(3): 362-370. https://doi.org/10.1093/europace/euq416.Mikhaylov E, Kanidieva A, Sviridova N, et al. Outcome of anatomic ganglionated plexi ablation to treat paroxysmal atrial fibrillation: A 3-year follow-up study. Europace. 2011;13(3): 362-370. https://doi.org/10.1093/europace/euq416.Pokushalov E, Romanov A, Shugayev P, et al. Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. Hear Rhythm. 2009;6(9): 1257-1264. https://doi.org/10.1016/j.hrthm.2009.05.018.Pokushalov E, Romanov A, Shugayev P, et al. Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. Hear Rhythm. 2009;6(9): 1257-1264. https://doi.org/10.1016/j.hrthm.2009.05.018.Miyoshi M, Kondo H, Ishii Y, et al. Baroreflex sensitivity in patients with atrial fibrillation. J Am Heart Assoc. 2020;9(24): e018019. https://doi.org/10.1161/JAHA.120.018019.Miyoshi M, Kondo H, Ishii Y, et al. Baroreflex sensitivity in patients with atrial fibrillation. J Am Heart Assoc. 2020;9(24): e018019. https://doi.org/10.1161/JAHA.120.018019.Styczkiewicz K, Spadacini G, Tritto M, et al. Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Med. 2019;20(5): 297-305. https://doi.org/10.2459/JCM.0000000000000791.Styczkiewicz K, Spadacini G, Tritto M, et al. Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Med. 2019;20(5): 297-305. https://doi.org/10.2459/JCM.0000000000000791.Ebert TJ, Cowley AW. Baroreflex modulation of sympathetic outflow during physiological increases of vasopressin in humans. Am J Physiol - Hear Circ Physiol. 1992;262(5): 31-5. https://doi.org/10.1152/ajpheart.1992.262.5.h1372.Ebert TJ, Cowley AW. Baroreflex modulation of sympathetic outflow during physiological increases of vasopressin in humans. Am J Physiol - Hear Circ Physiol. 1992;262(5): 31-5. https://doi.org/10.1152/ajpheart.1992.262.5.h1372.Davies LC, Francis DP, Scott AC, Ponikowski P, Piepoli M, Coats AJS. Effect of altering conditions of the sequence method on baroreflex sensitivity. J Hypertens. 2001;19(7): 1279-1287. https://doi.org/10.1097/00004872-20010700000013.Davies LC, Francis DP, Scott AC, Ponikowski P, Piepoli M, Coats AJS. Effect of altering conditions of the sequence method on baroreflex sensitivity. J Hypertens. 2001;19(7): 1279-1287. https://doi.org/10.1097/00004872-20010700000013.Davies LC, Francis D, Jurák P, Kára T, Piepoli M, Coats AJ. Reproducibility of methods for assessing baroreflex sensitivity in normal controls and in patients with chronic heart failure. Clin Sci (Lond). 1999;97(4): 515522.Davies LC, Francis D, Jurák P, Kára T, Piepoli M, Coats AJ. Reproducibility of methods for assessing baroreflex sensitivity in normal controls and in patients with chronic heart failure. Clin Sci (Lond). 1999;97(4): 515522.Robbe HW, Mulder LJ, Rüddel H, Langewitz WA, Veldman JB, Mulder G. Assessment of baroreceptor reflex sensitivity by means of spectral analysis. Hypertension. 1987;10(5): 538-543. https://doi.org/10.1161/01.HYP.10.5.538.Robbe HW, Mulder LJ, Rüddel H, Langewitz WA, Veldman JB, Mulder G. Assessment of baroreceptor reflex sensitivity by means of spectral analysis. Hypertension. 1987;10(5): 538-543. https://doi.org/10.1161/01.HYP.10.5.538.Takahashi N, Nakagawa M, Saikawa T, et al. Noninvasive assessment of the cardiac baroreflex: Response to downward tilting and comparison with the phenylephrine method. J Am Coll Cardiol. 1999;34(1): 211-215. https://doi.org/10.1016/S0735-1097(99)00158-8.Takahashi N, Nakagawa M, Saikawa T, et al. Noninvasive assessment of the cardiac baroreflex: Response to downward tilting and comparison with the phenylephrine method. J Am Coll Cardiol. 1999;34(1): 211-215. https://doi.org/10.1016/S0735-1097(99)00158-8.Davies LC, Francis DP, Jurák P, Kára T, Piepoli M, Coats AJS. Reproducibility of methods for assessing baroreflex sensitivity in normal controls and in patients with chronic heart failure. Clin Sci. 1999;97(4): 515-522. https://doi.org/10.1042/CS19990135.Davies LC, Francis DP, Jurák P, Kára T, Piepoli M, Coats AJS. Reproducibility of methods for assessing baroreflex sensitivity in normal controls and in patients with chronic heart failure. Clin Sci. 1999;97(4): 515-522. https://doi.org/10.1042/CS19990135.Rudas L, Crossman AA, Morillo CA, et al. Human sympathetic and vagal baroreflex responses to sequential nitroprusside and phenylephrine. Am J Physiol - Hear Circ Physiol. 1999;276(5 45-5): 1691-1698. https://doi.org/10.1152/ajpheart.1999.276.5.h1691. 27. Pitzalis MV, Mastropasqua F, Passantino A, et al. Comparison between noninvasive indices of baroreceptor sensitivity and the phenylephrine method in post-myocardial infarction patients. Circulation. 1998;97(14): 13621367. https://doi.org/10.1161/01.CIR.97.14.1362.Rudas L, Crossman AA, Morillo CA, et al. Human sympathetic and vagal baroreflex responses to sequential nitroprusside and phenylephrine. Am J Physiol - Hear Circ Physiol. 1999;276(5 45-5): 1691-1698. https://doi.org/10.1152/ajpheart.1999.276.5.h1691. 27. Pitzalis MV, Mastropasqua F, Passantino A, et al. Comparison between noninvasive indices of baroreceptor sensitivity and the phenylephrine method in post-myocardial infarction patients. Circulation. 1998;97(14): 13621367. https://doi.org/10.1161/01.CIR.97.14.1362.Lord SW, Clayton RH, Hall MCS, et al. Reproducibility of three different methods of measuring baroreflex sensitivity in normal subjects. Clin Sci. 1998;95(5): 575-581. https://doi.org/10.1042/cs0950575.Lord SW, Clayton RH, Hall MCS, et al. Reproducibility of three different methods of measuring baroreflex sensitivity in normal subjects. Clin Sci. 1998;95(5): 575-581. https://doi.org/10.1042/cs0950575.Oosting J, Struijker-boudier HAJ, Janssen BJA. Validation of a continuous baroreceptor reflex sensitivity index calculated from spontaneous fluctuations of blood pressure and pulse interval in rats. J Hypertens. 1997;15(4): 391-399. https://doi.org/10.1097/00004872-19971504000010.Oosting J, Struijker-boudier HAJ, Janssen BJA. Validation of a continuous baroreceptor reflex sensitivity index calculated from spontaneous fluctuations of blood pressure and pulse interval in rats. J Hypertens. 1997;15(4): 391-399. https://doi.org/10.1097/00004872-19971504000010.Maj R, Borio G, Osório TG, et al. Predictors of cardiac neuromodulation achieved by cryoballoon ablation performed in patients with atrial fibrillation who were in sinus rhythm before the ablation. Int J Cardiol. 2020;310(xxxx):Maj R, Borio G, Osório TG, et al. Predictors of cardiac neuromodulation achieved by cryoballoon ablation performed in patients with atrial fibrillation who were in sinus rhythm before the ablation. Int J Cardiol. 2020;310(xxxx):-91. https://doi.org/10.1016/j.ijcard.2020.01.033.-91. https://doi.org/10.1016/j.ijcard.2020.01.033.Călburean PA, Osório TG, Sieira J, et al. High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure. J Interv Card Electrophysiol. 2021;60(1): 21-29. https://doi.org/10.1007/s10840-01900687-9.Călburean PA, Osório TG, Sieira J, et al. High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure. J Interv Card Electrophysiol. 2021;60(1): 21-29. https://doi.org/10.1007/s10840-01900687-9.Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Länsimies E. Age and gender dependency of baroreflex sensitivity in healthy subjects. J Appl Physiol. 1998;84(2): 576-583. https://doi.org/10.1152/jappl.1998.84.2.576.Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Länsimies E. Age and gender dependency of baroreflex sensitivity in healthy subjects. J Appl Physiol. 1998;84(2): 576-583. https://doi.org/10.1152/jappl.1998.84.2.576.Yee KM, Struthers AD. Aldosterone blunts the baroreflex response in man. Clin Sci. 1998;95(6): 687-692. https://doi.org/10.1042/cs0950687.Yee KM, Struthers AD. Aldosterone blunts the baroreflex response in man. Clin Sci. 1998;95(6): 687-692. https://doi.org/10.1042/cs0950687.

The authors declare that there are no conflicts of interest present.