The sympathetic innervation of the heart in patients with hypertension and persistent atrial fibrillation before and after radiofrequency ablation

The aim of the study was to evaluate sympathetic innervation of the heart in patients with hypertension and persistent atrial fibrillation (AF) before and after radiofrequency catheter ablation (RFA). A total of 27 patients with stage I-II hypertension (degree 1 -3) were included in the study. Patients with persistent AF (n=17) received intracardiac procedure and RFA (isolation of pulmonary vein antrum, posterior wall of the left atrium, and left isthmus of the heart). Ten patients did not have AF. Efficacy of RFA was assessed after 12 months. All patients were divided into subgroups according to the presence of the arrhythmia recurrence. Radionuclide scintigraphy with¹²³I-metaiodbenzylguanidine (¹²³I-MIBG) was performed to evaluate sympathetic activity of the myocardium. We estimated general sympathetic activity by the heart/ mediastinum (H/M) ratio and the indicator washout rate. Regional sympathetic activity was assessed by measuring the filling defect of¹²³I-MIBG. The analysis of data showed that the H/M ratio was significantly lower in patients with AF compared with the corresponding value in patients without AF (1.70±0.14 vs. 1.96+0.08 on early scintigrams, р=0.005; 1.68+0.12 vs. 2.0±0.14 on delayed scintigrams, р=0.001). These results indicate that AF contributes to the worsening of the heart sympathetic activity in the presence of hypertension. Subjective improvement of the health and improvement in the general sympathetic cardiac function were observed in all patients after RFA: the early and delayed H/M ratios significantly increased from 1.70+0.14 to 1.97±0.21 (р=0.001) and from 1.68+0.12 to 1.96±0.12 (р=0.003), respectivley. The significant improvement in both general and regional sympathetic cardiac function was shown in patients with the efficient RFA compared with the subgroup of recurrent AF (early H/M ratio of 2.0+0.17 in patients with effective RFA vs. 1.77±0.01 in patients with ineffective RFA, p=0.021; indicator washout rate of 9.5±1.24% vs. 17.9±1.05%, p=0.004;¹²³I-MIBG filling defect of 6.8+0.43% vs. 13.5±0.75%, p=0.001, correspondingly).

фибрилляция предсердий, радиочастотная аблация, ¹²³1-МИБГ , симпатическая иннервация, atrial fibrillation, radiofrequency ablation, ¹²³I-MIBg , sympathetic innervation

1. Бокерия Л.А., Ревишвили А.Ш., Оганов Р.Г. и др. Клинические рекомендации по диагностике и лечению пациентов с фибрилляцией предсердий // Вестник аритмологии. - 2010. - № 59. - С. 53-77.

2. Ревишвили А.Ш., Рзаев Ф.Г., Баимбетов А.К. Электрофизиологическая оценка результатов повторных процедур радиочастотной аблации фибрилляции предсердий // Вестник аритмологии. - 2009. - № 57. - С. 29-40.

3. Akutsu Y., Kaneko K., Kodama Y. et al. Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation // Eur. J. Nucl. Med. Mol. Imaging. - 2010. - Vol. 37(4). -P. 742-749.

4. Allessie M.A., Boyden P.A., Camm A.J. et al. Pathophysiology and prevention of atrial fibrillation // Circulation. - 2001. -Vol. 103(5). - P. 769-777.

5. Aronow W.S., Ahn C., Mercando A.D. et al. Correlation of atrial fibrillation, paroxysmal supraventricular tachycardia, and sinus rhythm with incidences of new coronary events in 1, 359 patients, mean age 81 years, with heart disease // Am. J. Cardiol. - 1995. - Vol. 75. - P. 182-184.

6. Bajpai A., Savelieva I. Epidemiology and economic burden of atrial fibrillation // AJ CammUS Cardiology. - 2007. - Vol. 4. -Р. 14-17.

7. Berruezo A., Tamborero D., Mont L. et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation // Eur. Heart J. - 2007. - Vol. 28. -P. 836-841.

8. Goette A., Bukowska A., Dobrev D. et al. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles // Eur. Heart J. - 2009. - Vol. 30(11). - P. 1411-1420.

9. Hof I., Chilukuri K., Arbab-Zadeh A. et al. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? // J. Cardiovasc. Electrophysiol. - 2009. - Vol. 20. - P. 1005-1010.

10. Jiang H., Lu Z., Lei H. et al. Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease // J. Interv. Card. Electrophysiol. - 2006. - Vol. 15. - P. 157-163.

11. Verma A. The techniques for catheter ablation of paroxysmal and persistent atrial fibrillation: a systematic review // Curr. Opin. Cardiol. - 2011. - Vol. 26. - P. 17-24.

12. Wieland D.M., Brown L.E., Rogers W.L. et al. Myocardial imaging with a radioiodinated norepinephrine storage analog // J. Nucl. Med. - 1981. - Vol. 22(1). - P. 22-31.

13. Workman A.J. Cardiac adrenergic control and atrial fibrillation // Naunyn-Schmiedeberg’s Archives of Pharmacology. - 2010. - Vol. 381(3). P. 235-249.