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CLINICAL STUDIES: ELECTROPHYSIOLOGY

Increased sympathetic activity after atrioventricular junction ablation in patients with chronic atrial fibrillation

^a University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, Texas, USA
^* Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA

Manuscript received September 23, 1999; revised manuscript received December 16, 1999, accepted March 1, 2000.

Reprint requests and correspondence: Dr. Mohamed H. Hamdan, Dallas Veterans Affairs Medical Center, Division of Cardiology (111A), 4500 S. Lancaster Road, Dallas, Texas 75216
Hamdan{at}ryburn.swmed.edu

OBJECTIVES

The aim of this study was to determine the changes in sympathetic nerve activity (SNA) after atrioventricular junction (AVJ) ablation in patients with chronic atrial fibrillation (AF).

BACKGROUND

Polymorphic ventricular tachycardia (PMVT) has been reported after AVJ ablation in patients paced at a rate of 70 beats/min. We hypothesized that AVJ ablation results in sympathetic neural changes that favor the occurrence of PMVT and that pacing at 90 beats/min attenuates these changes.

METHODS

Sympathetic nerve activity, 90% monophasic cardiac action potential duration (APD₉₀), right ventricular effective refractory period (ERP) and blood pressure measurements were obtained in 10 patients undergoing AVJ ablation. Sympathetic nerve activity was analyzed at baseline and during and after successful AVJ ablation for at least 10 min. Data were also collected after ablation at pacing rates of 60 and 90 beats/min. The APD₉₀ and ERP were measured before and after AV block during pacing at 120 beats/min.

RESULTS

Sympathetic nerve activity increased to 134 ± 16% of the pre-ablation baseline value (p < 0.01) after successful AVJ ablation plus pacing at 60 beats/min and decreased to 74 ± 8% of baseline (p < 0.05) with subsequent pacing at 90 beats/min. Both APD₉₀ and ERP increased significantly.

CONCLUSIONS

1) Ablation of the AVJ followed by pacing at 60 beats/min is associated with an increase in SNA. 2) Pacing at 90 beats/min decreases SNA to or below the pre-ablation baseline value. 3) Cardiac APD and ERP increase after AVJ ablation. The increase in SNA, along with the prolongation in APD, may play a role in the pathogenesis of ventricular arrhythmias that occur after AVJ ablation.

Abbreviations and Acronyms   AF = atrial fibrillation   APD = action potential duration   AVJ = atrioventricular junction   BP = blood pressure   ERP = effective refractory period   HR = heart rate   MAP = monophasic action potential   PMVT = polymorphic ventricular tachycardia   RF = radiofrequency   RV = right ventricular   SNA = sympathetic nerve activity   VF = ventricular fibrillation

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