Evaluation of the effect of radiofrequency catheter ablation on autonomic function in patients with atrioventricular nodal reentrant tachycardia by head-up tilt table test

Vahid Jorat, Mohammad; Eftekharzadeh, Sayyed Ali; Mirzaei, Masoud; Owlia, Mohammadbagher; Sartipzadeh, Nasser Hosein; Salami, Maryam-Alsadat; Vafaeenasab, Mohammadreza; Rahimianfar, Ali Akbar; Shamibaf, Marzieh; Jafarieh, Minoo; Seyfpourshouraki, Zeynolabedin; Sarebanhassanabadi, Mohammadtaghi

Evaluation of the effect of radiofrequency catheter ablation on autonomic function in patients with atrioventricular nodal reentrant tachycardia by head-up tilt table test

Authors

Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: One of the recommended treatments for atrioventricular nodal reentrant tachycardia (AVNRT),
is radiofrequency catheter ablation (RFCA). However, RFCA may affect the autonomic system. This
study aims to evaluate the effect of RFCA on autonomic system in patients with PSVT by head‑up tilt
table (HUTT) test.
Materials and Methods: In a before–after study, 22 patients with PSVT were enrolled. Data were collected
with a data collection form that included two parts. Electrocardiogram (ECG), echocardiogram, 24‑h Holter
monitoring, HUTT test, heart rate variability (HRV) indexes, and symptoms of all patients were recorded
24 h before and 1 month after the ablation. Wilcoxon, McNemar, Mann–Whitney U, and Chi‑square tests
were used to analyze the data.
Results: Of the total 22 patients, 31.8% were male and 68.2% were female. There were significant differences
in heart palpitation (P < 0.0001) and non‑specific symptoms (P = 0.031) and no significant difference in
head‑up tilt test results and HRV indices before and after RFCA. The results showed that there were no
significant differences in specific and non‑specific symptoms in patients with AVNRT with positive and
negative HUTT before and after RFCA.
Conclusions: The observed difference in heart palpitation and non‑specific symptoms emphasized the role
of AVNRT in causing these symptoms. Autonomic dysfunction is more probably an accompanying condition
of AVNRT than causing symptoms. We could not find any significance in the results of HUTT after RFCA.
HUTT cannot determine or predict the symptoms after RFCA.

Keywords

References

1.	Psychari SN, Theodorakis GN, Koutelou M, Livanis EG, Kremastinos DT. Cardiac denervation after radiofrequency ablation of supraventricular tachycardias. Am J Cardiol 1998;81:725-31.
2.	Yamashita S, Yamane T, Matsuo S, Ito K, Narui R, Hioki M, et al. Improvement of atrioventricular conduction following catheter ablation of atrioventricular nodal reentry tachycardia in a patient with a prolonged PR interval. Heart Vessels 2013;28:120-5.
3.	Amasyali B, Kilic A, Kabul HK, Imren E, Acikel C. Patients with drug-refractory atrioventricular nodal reentrant tachycardia: Clinical features, electrophysiological characteristics, and predictors of medication failure. J Cardiol 2014. pii: S0914-5087(14)00029-X.
4.	Havranek S, Souckova L, Simek J, Wichterle D. Slow pathway ablation for typical atrioventricular nodal re-entrant tachycardia significantly alters the autonomic modulation of atrioventricular conduction. Clin Auton Res 2013;23:289-95.
5.	Heydari A, Tayyebi M, Jami RD, Amiri A. Role of isoproterenol in predicting the success of catheter ablation in patients with reproducibly inducible atrioventricular nodal reentrant tachycardia. Tex Heart Inst J 2014;41:280-5.
6.	Kay GN, Epstein AE, Dailey SM, Plumb VJ. Role of radiofrequency ablation in the management of supraventricular arrhythmias: Experience in 760 consecutive patients. J Cardiovasc Electrophysiol 1993;4:371-89.
7.	Kocovic DZ, Harada T, Shea JB, Soroff D, Friedman PL. Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. Circulation 1993;88:1671-81.
8.	Friedman PL, Stevenson WG, Kocovic DZ. Autonomic dysfunction after catheter ablation. J Cardiovasc Electrophysiol 1996;7:450-9.
9.	Kamada S, Kawamura Y, Iida Y, Sato N, Hasebe N. An experimental study on the site dependency and mechanism of vagal denervation following radiofrequency catheter ablation for supraventricular arrhythmias including atrial fibrillation. Int Heart J 2008;49:493-506.
10.	Madrid AH, Mestre JL, Moro C, Vivas E, Tejero I, Novo L, et al. Heart rate variability and inappropriate sinus tachycardia after catheter ablation of supraventricular tachycardia. Eur Heart J 1995;16:1637-40.
11.	Uchida F, Kasai A, Omichi C, Fujii E, Teramura S, Yasuda M, et al. Effect of radiofrequency catheter ablation on parasympathetic denervation: A comparison of three different ablation sites. Pacing Clin Electrophysiol 1998;21:2517-21.
12.	Duru F, Bauersfeld U, Candinas R. Autonomic effects of radiofrequency catheter ablation. Europace 2000;2:181-5.
13.	Grimm DR. Neurally mediated syncope: A review of cardiac and arterial receptors. J Clin Neurophysiol 1997;14:170-82.
14.	Kaufmann H. Neurally mediated syncope and syncope due to autonomic failure: Differences and similarities. J Clin Neurophysiol 1997;14:183-96.
15.	Doi A, Miyamoto K, Uno K, Nakata T, Tsuchihashi K, Shimamoto K. Studies on hemodynamic instability in paroxysmal supraventricular tachycardia: Noninvasive evaluations by head-up tilt testing and power spectrum analysis on electrocardiographic RR variation. Pacing Clin Electrophysiol 2000;23:1623-31.
16.	Kapoor WN. Using a tilt table to evaluate syncope. Am J Med Sci 1999;317:110-6.
17.	Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope: A comprehensive literature review. Am J Med 1994;97:78-88.
18.	Forleo C, Guida P, Iacoviello M, Resta M, Monitillo F, Sorrentino S, et al. Head-up tilt testing for diagnosing vasovagal syncope: A meta-analysis. Int J Cardiol 2013;169:e49-50.
19.	Gursul E, Bayata S, Tuluce SY, Berilgen R, Safak O, Ozdemir E, et al. Parameters of heart rate variability can predict prolonged asystole before Head-up tilt table test. Ann Noninvasive Electrocardiol 2014. [Epub ahead of print].
20.	Hashimoto T, Fukatani M, Mori M, Hashiba K. Effects of standing on the induction of paroxysmal supraventricular tachycardia. J Am Coll Cardiol 1991;17:690-5.
21.	Leitch JW, Klein GJ, Yee R, Leather RA, Kim YH. Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response? Circulation 1992;85:1064-71.
22.	Waxman MB, Cameron DA. The reflex effects of tachycardias on autonomic tone. Ann N Y Acad Sci 1990;601:378-93.
23.	Auricchio A, Klein H, Trappe HJ, Wenzlaff P. Lack of prognostic value of syncope in patients with Wolff-Parkinson-White syndrome. J Am Coll Cardiol 1991;17:152-8.
24.	Paul T, Guccione P, Garson A Jr. Relation of syncope in young patients with Wolff-Parkinson-White syndrome to rapid ventricular response during atrial fibrillation. Am J Cardiol 1990;65:318-21.
25.	Emkanjoo Z, Alasti M, Arya A, Haghjoo M, Dehghani MR, Fazelifar AF, et al. Heart rate variability: Does it change after RF ablation of reentrant supraventricular tachycardia? J Interv Card Electrophysiol 2005;14:147-51.
26.	Verdino RJ, Tracy CM, Solomon AJ, Sale M, Barbey JT. Alterations in heart rate following radiofrequency ablation in the treatment of reentrant supraventricular arrhythmias: Relation to alterations in autonomic tone. J Interv Card Electrophysiol 1997;1:145-51.
27.	Geller C, Goette A, Carlson MD, Esperer HD, Hartung WM, Auricchio A, et al. An increase in sinus rate following radiofrequency energy application in the posteroseptal space. Pacing Clin Electrophysiol 1998;21:303-7.
28.	Soejima K, Akaishi M, Mitamura H, Ogawa S, Sakurada H, Okazaki H, et al. Increase in heart rate after radiofrequency catheter ablation is mediated by parasympathetic nervous withdrawal and related to site of ablation. J Electrocardiol 1997;30:239-46.
29.	Kowallik P, Escher S, Peters W, Braun C, Meesmann M. Preserved autonomic modulation of the sinus and atrioventricular nodes following posteroseptal ablation for treatment of atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 1998;9:567-73.
30.	Pürerfellner H, Mascherbauer R, Nesser HJ. Absence of significant changes in heart rate variability after slow pathway ablation of AV nodal reentrant tachycardia by using serial Holter recordings. Am Heart J 1998;136:259-63.
31.	Sehra R, Hubbard JE, Straka SP, Fineberg NS, Zipes DP, Englestein ED. Effect of radiofrequency catheter ablation of accessory pathways on autonomic tone in children. Cardiol Young 1999;9:377-83.
32.	Markowitz SM, Christini DJ, Stein KM, Mittal S, Iwai S, Slotwiner DJ, et al. Time course and predictors of autonomic dysfunction after ablation of the slow atrioventricular nodal pathway. Pacing Clin Electrophysiol 2004;27:1638-43.

Advanced Biomedical Research