Prognostic value of cardiac sympathetic nervous system in atrial fibrillation recurrence after catheter ablation

Q: What are the key findings of this study?

An increase in cardiac sympathetic nervous system activity (dWR ≧6.9%) at 3 months post-catheter ablation independently predicted late AF recurrence with HR 4.33.

Q: What does this research mean for the field?

Higher washout rate change (≥6.9%) at 3 months after catheter ablation is independently associated with increased late atrial fibrillation recurrence, with an adjusted hazard ratio of 4.33 (95% CI 2.30-8.16). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Y Fukuda; M Kawasaki; T Yamada; Mitsutoshi Asai; T Morita; A Kikuchi; T Kondo; Tsutomu Kawai; M Seo; J Nakamura; T Fujita; T Oshita; Yuki Kokubu; Y Furuta; M Yoshida

doi:10.1093/eurheartj/ehaf784.469

November 1, 2025European Heart Journal

Prognostic value of cardiac sympathetic nervous system in atrial fibrillation recurrence after catheter ablation

View Full Paper

Ask AI

Bookmark

Share

Key result

Increased cardiac sympathetic activity three months post-ablation predicts ~333% higher risk of late AF recurrence.

HR 4.33

Why the study?

Catheter ablation of AF may influence the cardiac sympathetic nervous system, but its association with late AF recurrence across ablation modalities and heart failure status was unclear.

Does the change in cardiac sympathetic nervous system washout rate (dWR) predict late atrial fibrillation recurrence after catheter ablation in patients with paroxysmal AF?

Key Points

This research examines how changes in the cardiac sympathetic nervous system after catheter ablation relate to atrial fibrillation recurrence.
Enrolled 165 paroxysmal atrial fibrillation patients scheduled for ablation.
Randomly assigned patients to cryoballoon (CB) or radiofrequency (RF) ablation.
Measured cardiac sympathetic nervous system activity using iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy before and after ablation.
Calculated washout rate change (dWR) and tracked late atrial fibrillation recurrence during follow-up.
Late atrial fibrillation recurrence occurred in 25% of patients without antiarrhythmic drugs.
Higher dWR (≥6.9%) was linked to a significantly increased risk of early atrial fibrillation recurrence.
Patients with higher dWR had an AF recurrence free rate of 52%, compared to 84% in those with low dWR.

Structured PICO

Does the change in cardiac sympathetic nervous system washout rate (dWR) predict late atrial fibrillation recurrence after catheter ablation in patients with paroxysmal AF?

P

Population

165 patients with paroxysmal atrial fibrillation scheduled for catheter ablation, with and without heart failure.

I

Intervention

Catheter ablation using cryoballoon (CB) or contact force sensing radiofrequency (RF) catheter, with cardiac iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy performed at baseline and 3 months post-ablation.

C

Comparator

Cryoballoon vs. Radiofrequency ablation; also comparison between patients with high (≧6.9%) vs. low washout rate change (dWR) on MIBG.

O

Outcome

Late atrial fibrillation recurrence (LAR) without any antiarrhythmic drugs.

An excessive increase in cardiac sympathetic nervous system washout rate at 3 months post-ablation is a strong independent predictor of late atrial fibrillation recurrence.

Implication

Post-ablation dWR ≥6.9% identifies high-risk patients for intensified monitoring; extends evidence linking sympathetic activity to late AF recurrence.

Abstract

Background Catheter ablation (CA) of atrial fibrillation (AF) might influence the cardiac sympathetic nervous system (CSNS). We investigated the association between the impact of AF ablation with cryoballoon catheter (CB) and contact force sensing radiofrequency catheter (RF) on CSNS and the late AF recurrence, using cardiac iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in patients with and without heat failure (HF). Methods and Results One hundred sixty-five paroxysmal AF patients who were scheduled for ablation were enrolled. All patients were randomly assigned to CB or RF. MIBG was performed at baseline and 3 months after ablation and the washout rate change (dWR) was calculated. During the follow-up period of 30±15 months after CA, late AF recurrence (LAR) was observed in 42 (25%) patients without any antiarrhythmic drugs. There was no significant difference in the rate of LAR between CB and RF. dWR was significantly greater in patients with than without LAR (4.5±9.3% vs -1.3±12.4%, p=0.007). LAR was significantly more frequently observed in patients with higher dWR ≧6.9%, which was a fair discriminator for early AF recurrence (AUC; 0.644 by ROC curve analysis), than those with low dWR (AF recurrence free rate; 52% vs 84%, p<0.0001). Higher dWR was independently associated with LAR (adjusted hazard ratio = 4.33, 95%CI [2.30-8.16], p<0.0001, adjusted for age, sex, and left atrial diameter). Conclusions Excessive adrenergic tone increase at 3 months after CA might be associated with LAR.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Fukuda et al. (2025) studied this question. An increase in cardiac sympathetic nervous system activity (dWR ≧6.9%) at 3 months post-catheter ablation independently predicted late AF recurrence with HR 4.33.

synapsesocial.com/papers/6988278b0fc35cd7a884657c https://doi.org/10.1093/eurheartj/ehaf784.469