Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD and Severe OSA: a sub group Analysis

Marcio Galindo Kiuchi, Shaojie Chen

Abstract


Accentuated sympathetic nerve activity is a strong danger feature for cardiovascular major episodes, such as cerebral and myocardial ischemia/infarction.  Peripheric sympathetic nerve activity is emphasized in the hypertensive state, congestive cardiac failure, OSA, heaviness, diabetes, and chronic kidney disease (CKD) subjects. Leastwise a half of individuals with hypertension present augmented sympathetic nerve activity. Our group believes that RSD can reduce AF recurrence in patients with CKD and OSA by modulation of the sympathetic hyperactivity present in these diseases. The goal of this prospective study was to compare the impact of different treatments including CPAP, PVI, RSD, and some combination of them in controlled hypertensive patients with paroxysmal AF, moderate CKD, and severe OSA. Our data suggest that the patients underwent RSD associated to CPAP treatment or PVI, or both of them presented an improvement in the renal function, a decrease in AHI and a lower chance to present AF recurrence than the ones that did not suffer this intervention. Although encouraging, our data are preliminary and need long-term validation in a large population.


Keywords


Paroxysmal atrial fibrillation; Moderate chronic kidney disease; Severe obstructive sleep apnea; Continuous positive airway pressure; Pulmonary vein isolation; Renal sympathetic denervation.

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European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31: 2369-429, 2010. DOI: 10.1093/eurheartj/ehq278

Pokushalov E, Romanov A, Corbucci G, Artyomenko S, Baranova V, Turov A, Shirokova N, Karaskov A, Mittal S, Steinberg JS: A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol 60: 1163-70, 2012. DOI: 10.1016/j.jacc.2012.05.036.

Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: the sleep heart health study. Am J Respir Crit Care Med 2006;173:910–6. DOI: 10.1164/rccm.200509-1442OC.

Kannel WB, Wolf PA, Benjamin EJ, etal. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol1998;82:2N–9N. PMID: 9809895.

Yan H, Aung TT, Guoqiang Z, et al. Meta-analysis of the effect of vernakalant on conversion of atrial fibrillation. BMC Res Notes 2013;6:94. DOI: 10.1186/1756-0500-6-94.

Hess PL, Jackson KP, Hasselblad V, et al. Is cardiac resynchronization therapy an antiarrhythmic therapy for atrial fibrillation? A systematic review and meta-analysis. Curr Cardiol Rep 2013;15:330. DOI: 10.1007/s11886-012-0330-6.

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC7 report. J Appl Med Assoc 2003; 289:2560–72. DOI: 10.1001/jama.289.19.2560.

Dong JY, Zhang YH, Qin LQ. Obstructive sleep apnea and cardiovascular risk: a meta-analysis of prospective cohort studies. Atherosclerosis 2013; 229:489–95. DOI: 10.1016/j.atherosclerosis.2013.04.026

Drager LF, Bortolotto LA, Figueiredo AC, et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007;176:706–12. DOI: 10.1164/rccm.200703-500OC.

Litvin A, Sukmarova Z, Elfimova E, et al. Effects of CPAP on “vascular” risk factors in patients with obstructive sleep apnea and arterial hypertension. Vasc Health Risk Manage2013 ;9:229–35. DOI: 10.2147/VHRM.S40231.

Asirvatham SJ, Kapa S. Sleep apnea, and atrial fibrillation: the autonomic link. J Am Coll Cardiol 2009;54:2084–6. DOI: 10.1016/j.jacc.2009.09.017.

Menezes AR, Lavie CJ, Dinicolantonio JJ, et al. Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies. Mayo Clin Proc 2013; 88:394–409. DOI: 10.1016/j.mayocp.2013.01.022.

Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110: 364–7. DOI: 10.1161/01.CIR.0000136587.68725.8E.

Rajagopalan N. Obstructive sleep apnea: not just a sleep disorder. J Postgrad Med 2011;57:168–75. DOI: 10.4103/0022-3859.81866.

Dimitri H, Ng M, Brooks AG, et al. Atrial remodeling in obstructive sleep apnea: implications fo ratrial fibrillation. Heart Rhythm 2012; 9:321–7. DOI: 10.1016/j.hrthm.2011.10.017.

Linz D, Schotten U, Neuberger HR, et al. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm 2011;8:1436–43. DOI: 10.1016/j.hrthm.2011.03.053.

Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002; 105:2462–4. DOI.org/10.1161/01.CIR.0000018948.95175.03

Hartmann G, Tschop M, Fischer R, et al. High altitude increases circulating interleukin-6, interleukin-1 receptor antagonist, and C-reactive protein. Cytokine 2000;12: 246–52. DOI: 10.1006/cyto.1999.0533.

Julius S, Jamerson K. Sympathetics, insulin resistance and coronary risk in hypertension: the chicken-and-egg question. J Hypertens 1994; 12: 495–502. PMID: 7930548.

Esler M, Lambert G, Brunner-La Rocca HP, Vaddadi G, Kaye D. Sympathetic nerve activity and neurotransmitter release in humans: translation from pathophysiology into clinical practice. Acta Physiol Scand 2003; 177: 275–284. DOI: 10.1046/j.1365-201X.2003.01089.x.

Esler M. The 2009 Carl Ludwig Lecture: pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. J Appl Physiol 2010; 108: 227–237. DOI: 10.1152/japplphysiol.00832.2009.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration): A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150: 604–612. PMID: 19414839.

Joshi S, Choi AD, Kamath GS, Raiszadeh F, Marrero D, Badheka A, Mittal S, Steinberg JS: Prevalence, predictors, and prognosis of atrial fibrillation early after pulmonary vein isolation: Findings from 3 months of continuous automatic ECG loop recordings. J Cardiovasc Electrophys 2009;20: 1089 –94. DOI: 10.1111/j.1540-8167.2009.01506.

Pokushalov E, Romanov A, Corbucci G, Artyomenko S, Turov A, Shirokova N, Karaskov A: Ablation of paroxysmal and persistent atrial fibrillation: 1-year follow-up through continuous subcutaneous monitoring. J Cardiovasc Electrophysiol 2011;22: 369–75. DOI: 10.1111/j.1540-8167.2010.01923.

Kiuchi MG, E Silva GR, Paz LM, Chen S, Souto GL. Proof of concept study: renal sympathetic denervation for treatment of polymorphic premature ventricular complexes. J Interv Card Electrophysiol. 2016;47:221-229. DOI: 10.1007/s10840-016-0146-1.

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4.




DOI: https://doi.org/10.17987/icfj.v12i0.428


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