Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hypertens. May 23, 2015; 5(2): 98-103
Published online May 23, 2015. doi: 10.5494/wjh.v5.i2.98
Catheter ablation for atrial fibrillation in a subset of patients with concomitant hypertension
Tushar Sharma, Benjamin J Scherlag, Hiroshi Nakagawa, Warren M Jackman, Ralph Lazzara, Sunny S Po
Tushar Sharma, Benjamin J Scherlag, Hiroshi Nakagawa, Warren M Jackman, Ralph Lazzara, Sunny S Po, Heart Rhythm Institute at the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
Author contributions: All authors contributed to this manuscript.
Supported by The Heart Rhythm Institute at the University of Oklahoma Health Sciences Center (SSP) and the Helen; and Wil Webster Arrhythmia Research Fund of the University of Oklahoma Foundation (BJS).
Ethics approval: This is a retrospective study which does not require IRB evaluation. See informed consent below.
Informed consent: All patient provided informed consent prior to the catheter ablation procedure for the treatment of atrial fibrillation. Included in that consent was the collection and publication of follow-up data.
Conflict-of-interest: Tushar Sharma, Benjamin J Scherlag, Ralph Lazzara and Sunny S Po have no conflicts to disclose; Hiroshi Nakagawa: Research Grant by Biosense Webster, Inc., St. Jude Medical AF Division, EndoSense SA and Boston Scientific; Warren M Jackman is Consultant of Biosense Webster, EndoSense SA, Rhythmia Medical, ACT, VyTronUS, CyberHeart and Cardiofocus.
Data sharing: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Benjamin J Scherlag, PhD, Heart Rhythm Institute at the University of Oklahoma Health Sciences Center, 1200 Everett Drive (6E103), Oklahoma City, OK 73104, United States. benjamin-scherlag@ouhsc.edu
Received: September 30, 2014
Peer-review started: October 5, 2014
First decision: December 12, 2014
Revised: January 31, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 23, 2015
Processing time: 232 Days and 15.2 Hours
Abstract

AIM: To study patients with atrial fibrillation and hypertension who had successful catheter ablation for changes in blood pressure 1 year later.

METHODS: A retrospective study was performed on patients who had catheter ablation for atrial fibrillation (AF) and hypertension (HTN) which included local autonomic ganglionated plexi denervation and pulmonary veins isolation. Of the records of 119 patients, follow-up data was found in order to determine the presence of sinus rhythm and data on systolic (SBP) and diastolic blood pressure at 2 wk, 3 mo, 6 mo and 1 year after the ablation procedure. Transthoracic echocardiograms were taken at the time of the catheter procedure to determine left atrial dimensions (LADs) and left ventricular size.

RESULTS: There was no significant difference in the pre-ablation mean blood pressures between the two groups (P = 0.08). After 1 year 33 of the 60 with AF and HTN were in sinus rhythm, of whom 12 had normal LADs, ≤ 4 cm Group 1, and 21 had enlarged left atria (LADs > 4 cm, Group 2). For Group 1, at 1 year of follow up, there was a significant difference in the SBP (119.2 ± 13 mmHg) compared to pre-ablation (142.6 ± 13.7 mmHg, P = 0.001). For Group 2, there was no significant difference in the SBP, pre-ablation (130.3 ± 17.5 mmHg) and at 1 year of follow up (130.4 ± 13.4 mmHg, P = 0.75). All patients were on similar anti-hypertensive medications. There was a trend for a greater left ventricular size in Group 2 compared to Group 1.

CONCLUSION: We suggest that Group 1 had HTN due to sympathetic hyperactivity, neurogenic HTN; whereas HTN in Group 2 was based on arterial vasoconstriction.

Keywords: Atrial fibrillation; Hypertension; Autonomic nervous system; Catheter ablation

Core tip: A retrospective study of 119 patient with atrial fibrillation (AF) and hypertension (HTN) underwent catheter ablation consisting of pulmonary vein isolation and local cardiac autonomic denervation. After 1 year 33 were in sinus rhythm and fell into 2 categories based on significant differences in left atrial dimensions (LADs). Although similarly medicated, Group I (LADs ≤ 4 cm) had a significant decrease in blood pressure compared to Group 2, LAD > 4 cm. We conclude that HTN in Group 1 was neurogenic and ameliorated by neural ablation; whereas HTN in Group 2, manifested arterial vasoconstriction as the mechanism for HTN.