Key result
Radiofrequency surgical ablation in patients with long-standing persistent atrial fibrillation resulted in a significantly lower heart-to-mediastinum ratio compared to patients with sinus rhythm (1.5 vs 1.8, p=0.02).
Why the study?
The autonomic nervous system modulates cardiac electrophysiology, and the study aimed to evaluate the link between surgical AF ablation efficacy, neurohumoral transmitter levels, and myocardial 123I-MIBG uptake.
Does radiofrequency surgical ablation of long-standing persistent AF reduce norepinephrine levels and alter 123I-MIBG uptake in patients undergoing mitral valve surgery?
RCT (n=68)
Envelopes
Does radiofrequency surgical ablation of long-standing persistent AF reduce norepinephrine levels and alter 123I-MIBG uptake in patients undergoing mitral valve surgery?
Absolute Event Rate: 1.5% vs 1.8%
p-value: p=0.02
The aortic root and coronary sinus gradient of norepinephrine levels can serve as a quantitative marker to predict the efficacy of surgical radiofrequency ablation for long-standing persistent atrial fibrillation.
Supports sympathetic denervation during mitral valve surgery for long-standing persistent AF; extends NE gradient as quantitative efficacy marker in RCTs.
Background . The autonomic nervous system (ANS) plays an important role in modulation of cardiac electrophysiology and arrhythmogenesis. Disorders of the ANS components can be a prognostic factor of an unfavorable course of cardiovascular diseases. The aim of the study was to evaluate the association between efficacy of radiofrequency (RF) surgical ablation of long-standing persistent atrial fibrillation (AF) and neurohumoral transmitter levels as well as correlation between these data with myocardial iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) uptake. Methods . Two groups of patients with acquired valvular heart disease were compared: patients with surgical AF ablation and patients with sinus rhythm. Results. The decrease of norepinephrine (NE) level in coronary sinus has a direct association with the heart-to-mediastinum ratio (p=0.02) and negative correlation with 123 I-MIBG uptake defect (p=0.01). NE level decreased significantly after the main stage of surgery, both in patients with AF (p=0.0098) and sinus rhythm (p=0.0039). Furthermore, the significance (p=0.001) of the aortic root and coronary sinus gradient of NE level 0.405 pg/mL was determined as a cut-off value for efficacy evaluation of the RF denervation. Conclusion . The practical significance of the obtained results lies in the possibility of using the technique to predict the efficacy of the ‘Maze-IV’ procedure, which will allow assessing the risk of AF recurrence after ablation.
No takes yet. Share an insight, caveat, or question.
Евтушенко et al. (2021) conducted an RCT in Long-standing persistent atrial fibrillation and mitral valve disease (n=68). Radiofrequency surgical ablation vs. Sinus rhythm patients undergoing valve surgery without ablation was evaluated on Heart-to-mediastinum ratio in the late phase after intervention (p=0.02). Radiofrequency surgical ablation in patients with long-standing persistent atrial fibrillation resulted in a significantly lower heart-to-mediastinum ratio compared to patients with sinus rhythm (1.5 vs 1.8, p=0.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: