Catheter-based pulmonary vein isolation fails to prevent transient atrial arrhythmogenic changes related to acute obstructive respiratory events in a porcine model
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Catheter-based pulmonary vein isolation fails to prevent transient atrial arrhythmogenic changes related to acute obstructive respiratory events in a porcine model. / Norup Hertel, Julie; Isaksen, Jonas L.; Jerltorp, Kezia; Dalgas Nissen, Sarah; Hansen, Malthe; Saljic, Arnela; Linz, Benedikt; Sattler, Stefan; Ye, Charles; Overgaard Larsen, Jakob; Nørregaard, Malene; Chaldoupi, Sevasti Maria; Gang, Uffe; Manninger, Martin; Jespersen, Thomas; Linz, Dominik.
In: Europace, Vol. 26, No. 6, euae132, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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T1 - Catheter-based pulmonary vein isolation fails to prevent transient atrial arrhythmogenic changes related to acute obstructive respiratory events in a porcine model
AU - Norup Hertel, Julie
AU - Isaksen, Jonas L.
AU - Jerltorp, Kezia
AU - Dalgas Nissen, Sarah
AU - Hansen, Malthe
AU - Saljic, Arnela
AU - Linz, Benedikt
AU - Sattler, Stefan
AU - Ye, Charles
AU - Overgaard Larsen, Jakob
AU - Nørregaard, Malene
AU - Chaldoupi, Sevasti Maria
AU - Gang, Uffe
AU - Manninger, Martin
AU - Jespersen, Thomas
AU - Linz, Dominik
N1 - Publisher Copyright: © 2024 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2024
Y1 - 2024
N2 - Aims: Pulmonary vein isolation (PVI) is the corner stone of modern rhythm control strategies in patients with atrial fibrillation (AF). Sleep-disordered breathing (SDB) is prevalent in more than 50% of patients undergoing AF ablation, and studies have indicated a greater recurrence rate after PVI in patients with SDB. Herein, we study the effect of catheter-based PVI on AF in a pig model for SDB. Methods and results: In 11 sedated spontaneously breathing pigs, obstructive apnoeas were simulated by 75 s of intermittent negative upper airway pressure (INAP) applied by a negative pressure device connected to the endotracheal tube. Intermittent negative upper airway pressures were performed before and after PVI. AF-inducibility and atrial effective refractory periods (aERPs) were determined before and during INAP by programmed atrial stimulation. Pulmonary vein isolation prolonged the aERP by 48 ± 27 ms in the right atrium (RA) (P < 0.0001) and by 40 ± 34 ms in the left atrium (LA) (P = 0.0004). Following PVI, AF-inducibility dropped from 28 ± 26% to 0% (P = 0.0009). Intermittent negative upper airway pressure was associated with a transient aERP-shortening (ΔaERP) in both atria, which was not prevented by PVI (INAP indued ΔaERP after PVI in the RA: -57 ± 34 ms, P = 0.0002; in the LA: -42 ± 24 ms, P < 0.0001). Intermittent negative upper airway pressure was associated with a transient increase in AF-inducibility (from 28 ± 26% to 69 ± 21%; P = 0.0008), which was not attenuated by PVI [INAP-associated AF-inducibility after PVI: 58 ± 33% (P = 0.5)]. Conclusion: Transient atrial arrhythmogenic changes related to acute obstructive respiratory events are not prevented by electrical isolation of the pulmonary veins, which partially explains the increased AF recurrence in patients with SDB after PVI procedures.
AB - Aims: Pulmonary vein isolation (PVI) is the corner stone of modern rhythm control strategies in patients with atrial fibrillation (AF). Sleep-disordered breathing (SDB) is prevalent in more than 50% of patients undergoing AF ablation, and studies have indicated a greater recurrence rate after PVI in patients with SDB. Herein, we study the effect of catheter-based PVI on AF in a pig model for SDB. Methods and results: In 11 sedated spontaneously breathing pigs, obstructive apnoeas were simulated by 75 s of intermittent negative upper airway pressure (INAP) applied by a negative pressure device connected to the endotracheal tube. Intermittent negative upper airway pressures were performed before and after PVI. AF-inducibility and atrial effective refractory periods (aERPs) were determined before and during INAP by programmed atrial stimulation. Pulmonary vein isolation prolonged the aERP by 48 ± 27 ms in the right atrium (RA) (P < 0.0001) and by 40 ± 34 ms in the left atrium (LA) (P = 0.0004). Following PVI, AF-inducibility dropped from 28 ± 26% to 0% (P = 0.0009). Intermittent negative upper airway pressure was associated with a transient aERP-shortening (ΔaERP) in both atria, which was not prevented by PVI (INAP indued ΔaERP after PVI in the RA: -57 ± 34 ms, P = 0.0002; in the LA: -42 ± 24 ms, P < 0.0001). Intermittent negative upper airway pressure was associated with a transient increase in AF-inducibility (from 28 ± 26% to 69 ± 21%; P = 0.0008), which was not attenuated by PVI [INAP-associated AF-inducibility after PVI: 58 ± 33% (P = 0.5)]. Conclusion: Transient atrial arrhythmogenic changes related to acute obstructive respiratory events are not prevented by electrical isolation of the pulmonary veins, which partially explains the increased AF recurrence in patients with SDB after PVI procedures.
KW - Atrial fibrillation
KW - Autonomic nervous system
KW - Pulmonary vein isolation
KW - Sleep apnoea
U2 - 10.1093/europace/euae132
DO - 10.1093/europace/euae132
M3 - Journal article
C2 - 38758963
AN - SCOPUS:85196066417
VL - 26
JO - Europace
JF - Europace
SN - 1099-5129
IS - 6
M1 - euae132
ER -
ID: 396733044