MP-453081-9 CARDIAC SYMPATHOEXCITATION MONITORING DURING PULMONARY VEIN ISOLATION BY PSYCHOGENIC SWEATING: POSSIBILITY OF REPRESENTING CARDIAC SYMPATHETIC NEUROMODULATION

Abstract

Vagal responses during pulmonary vein isolation (PVI) have been reported, suggesting cardiac neuromodulation in atrial fibrillation (AF) patients. The cardiac sympathetic nervous system also innervates the left atrium (LA) and its nerve fibers are reported to be greatly distributed around the PV antrum. However, the sympathetic nervous system’s response during PVI is unclear and the precise method to evaluate the cardiac sympathetic reflex is still not established. Psychogenic sweating (skin potential response; SPR) occurs during sympathetic excitation and may be useful to represent cardiac sympathoexcitation during PVI. We investigated whether the SPR could represent a cardiac sympathetic response during a balloon-based PVI and considered its clinical implications in persistent AF patients. Eighty persistent AF patients (Hot-balloon;45pt, Cryoballoon;35pt) were enrolled and the SPR was monitored during balloon-based ablation of each PV. The SPR was measured by the difference in two skin potentials recorded from skin electrodes (Figure top row). The reduction in the activation recovery interval (ARI), suggesting sympathetic excitation, was examined from the ventricle unipolar electrogram of the great cardiac vein recorded from an electrode catheter placed inside the coronal sinus (Figure bottom row). An ROC analysis was used to determine a valid reduction in the SPR, with a reduction cut-off value of 3.5mV in the heart rate (HR) increase due to sympathoexcitation (sensitivity 73%, specificity 97%). SPRs occurred in 41% of the PVs (LSPV=41%, RSPV=38%, LIPV=28%, RIPV=20%). The SPR was related to a significant increase in the blood pressure and HR, and a reduction in the ARI (p<0.01, Table). A total of 18 patients (20%) had AF recurrences within the 1-year follow-up. The number of SPRs within the 4PVs was 1.08PV in non-recurrence patients and 1.83PV in AF recurrent patients (p=0.07). The patients that had early recurrences but recovered sinus rhythm (SR) within 3 months, had more frequent SPRs than the other recurrent patients (2.80 vs. 0.63PV, p<0.01). The SPR was strongly related to cardiac sympathoexcitation during PVI. The SPR was suggested to represent the cardiac sympathetic reflex during PV antrum ablation, which may lead to an investigation of the cardiac sympathetic neuromodulation during PVI. Frequent SPRs were related to SR recovery after early AF recurrences and a cardiac sympathetic response may have an important role in the outcome of the PVI.