Evidence map›Paper›PMID 30661160›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2019

Clinical evidence of autonomic dysfunction due to atrial fibrillation: implications for rhythm control strategy.

Varun Malik, Douglas J McKitrick, Dennis H Lau, Prashanthan Sanders, Leonard F Arnolda

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Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Varun MalikCentre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Douglas J McKitrickDepartment of Cardiology, Royal Perth Hospital, Perth, Australia.
Dennis H LauCentre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Prashanthan SandersCentre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Leonard F ArnoldaIllawarra Health and Medical Research Institute, Building 32, University of Wollongong, Wollongong, NSW, 2522, Australia. larnolda@uow.edu.au.ORCID http://orcid.org/0000-0001-8173-3318

Funding

Cardiovascular Lipid Grant (Australian Independent Physicians Committee- awarded by Pfizer) CV120.10Edwards Lifesciences N/A: Loan of equipment
6 · The paper itself

Abstract

purposeThe role of the autonomic nervous system in the genesis of atrial fibrillation (AF) has been well studied; however, the converse remains poorly understood. Pulmonary veins (PV) contain receptors important in cardiac reflexes. Here, we evaluated reflex responses in patients with paroxysmal AF (PAF) to lower body negative pressure (LBNP).

methodsThirty-four PAF patients (including 14 PAF patients post successful PV Isolation; PVI) were compared to 14 age and sex-matched controls. Mean arterial pressure (MAP), heart rate (HR), systemic vascular resistance index (SVRI), cardiac index (CI), and stroke volume index (SVI) were measured continuously during - 0, - 20, and - 40 mmHg LBNP. LBNP reduces venous return, deactivating atrial receptors, thereby eliciting a reflex increase in SVRI to maintain MAP.

resultsAF patients have higher BMI than the controls (p = 0.02). In control subjects, LBNP did not alter MAP as SVRI increased. In PAF patients, LBNP resulted in a reduction in MAP (- 4.8%) with attenuated SVRI response (+ 4.2%) compared to controls (p < 0.05). However, in the post-PVI group, SVRI increase was similar to controls (p = 0.12) although that was insufficient to maintain MAP. In all patients, both reduction in SVI and CI and increase in HR were similar in response to LBNP.

conclusionsThis study provides novel clinical evidence of autonomic dysfunction in PAF patients. Successful PVI results in partial recovery of the cardiac reflex. Therefore, not only does autonomic disturbance predispose to AF but it is also a consequence of AF; potentially contributing to disease progression. This could help explain the dictum "AF begets AF."

Indexed as

Lower Body Negative PressureAtrial FibrillationAutonomic Nervous SystemCase-Control StudiesCatheter AblationElectrophysiologic Techniques, CardiacFemaleHumansMaleMiddle AgedPulmonary VeinsAtrial fibrillationAutonomic nervous systemLower body negative pressureOrthostatic reflexesPulmonary vein isolation

Identifiers

PMID30661160

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.