Author + information
- Evgeny Shlyakhto,
- Oleg Mamontov,
- Edvard Berngardt,
- Evgeny Mikhailov,
- Dmitry Lebedev and
- Alexandra Konradi
Occurrence and progression of coronary artery disease (CAD) and heart failure (HF) are accompanied by worsening of autonomic regulation of circulation. In its turn, this contributes to development of supraventricular arrhythmias. In this connection, neural activity modulation may be an effective approach to treatment and prevention.
Estimation of sympathetic and parasympathetic activity in 40 patients with CAD and paroxysmal atrial fibrillation (AF) and in 40 healthy subjects was performed by Valsalva maneuver test, evaluation of heart rate variability (HRV) and blood pressure (BP) followed by calculation of spontaneous baroreflex value (Finometer-PRO). Approaches to autonomic activity modulation included atrial sympathetic ganglia ablation and pulmonary veins isolation. Renal artery ablation (RAA) was performed in presence of resistant hypertension.
Autonomic regulation of circulation was characterized by decrease in parasympathetic and increase in sympathetic influence on the heart, particularly, in patients with diurnal paroxysmal AF. At the same time, arterial baroreflex magnitude was significantly higher in patients with AF related to enhanced sympathetic activation in comparison with control. Ablation of atrial sympathetic ganglia was accompanied by reduction of AF recurrence rate. However, this effect was less evident in comparison with the effect of pulmonary veins isolation. Moreover, HRV restoration in 3 months after ablation of sympathetic ganglia indicates the nondurable effect of this procedure. In the end, baroreflex restoration after RAA observed before may be an important mechanism of not only BP lowering but also reduction of AF paroxysms rate.
Disorders of autonomic regulation of circulation is an important mechanism of arrhythmogenesis, so its modulation can be used in patients with AF as a therapeutic strategy.