Key result
Cryoballoon ablation for AF frequently causes neuromodulation, but additional clinical benefits remain debated.
Why the study?
The additional clinical benefit of neuromodulation during pulmonary vein isolation with cryoballoon ablation remains a matter of debate.
This review highlights the potential role of neuromodulation during cryoballoon ablation for atrial fibrillation, though its additional clinical benefit remains debated.
Pulmonary vein isolation (PVI) represents the mainstay of atrial fibrillation (AF) ablation, and PVI with cryoballoon catheter (CB) ablation (CB-A) has proven to be as effective and safe as radiofrequency ablation (RF-A). Although AF is initiated by triggers arising from the pulmonary veins (PV) and non-PV foci, the intrinsic cardiac nervous system (ICNS) plays a significant role in the induction and maintenance of AF. The ICNS is an epicardial neural system composed of ganglionated plexi (GPs) and a complex network of interconnecting neurons. In the left atrium, the major GPs are located in proximity to the PV-left atrial junction. Vagal reactions have been described as markers of autonomic modulation during PVI with both RF-A and CB-A. The occurrence of neuromodulation during PVI with CB-A may be explained by both the anatomical relationship between the GPs and the PVs and the characteristics of the CB. Due to the CB/PV size mismatch, the CB creates a wide ablation area that extends from the PV ostium toward the antrum, possibly including the GPs. Although targeted GPs ablation, as a supplemental strategy to PVI, has been associated with a better AF outcome in patients undergoing RF-A, the additional clinical benefit of neuromodulation during PVI with CB-A remains a matter of debate. In this review, we provide an overview of the anatomy of the ICNS, the relationship between the ICNS and AF pathophysiology, and the current evidence on the clinical relevance of neuromodulation during PVI with CB-A.
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Monte et al. (2022) conducted a review in Atrial fibrillation. Cryoballoon ablation was evaluated. Cryoballoon ablation for atrial fibrillation often results in concomitant neuromodulation due to its wide antral ablation area, though its additional clinical benefit on AF outcomes remains debated.
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