Key result
Vagal response during PVI predicts ~53% lower AF recurrence at 6 but not 12 months.
Why the study?
Vagal responses often occur during circumferential pulmonary vein isolation, but whether their presence impacts post-ablation recurrence in paroxysmal AF was unknown.
Does the presence of a vagal response during circumferential pulmonary vein isolation reduce the recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation?
Observational (n=112)
Does the presence of a vagal response during circumferential pulmonary vein isolation reduce the recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation?
Absolute Event Rate: 8.5% vs 17.9%
p-value: p=0.023
Vagal responses during CPVI for paroxysmal AF are associated with a short-term reduction in AF recurrence and transiently accelerated mean heart rate, but this benefit does not persist at 12 months.
Vagal response during CPVI was associated with lower short-term AF recurrence; leaves open its value as a long-term prognostic marker in paroxysmal AF.
BACKGROUND: Vagal responses (VRs) are often seen in patients undergoing circumferential pulmonary vein isolation (CPVI). The possible mechanism of VR is that CPVI creates a coincidental modification of the cardiac ganglionated plexi (GP). AIM: To investigate whether the presence of VR during CPVI impacts post-ablation recurrence in patients with paroxysmal atrial fibrillation (AF). METHODS: A total of 112 consecutive patients with symptomatic paroxysmal AF who underwent CPVI for the first time from October 1, 2017 to April 30, 2019 were prospectively enrolled, of which two were lost the follow-up. Patients were divided into two groups based on whether VRs were experienced during CPVI. Electrophysiological parameters, including atrial effective refractory period (AERP) and mean heart rate (MHR), were measured before and post-ablation. The patients were then followed up for 12 months. RESULTS: The 71 patients who had experienced VRs during CPVI were assigned to group B, and the remaing 39 patients who did not experience VR during CPVI were assigned to group A. The MHR (79.6 ± 8.3 vs 70.4 ± 7.8 b/min; p ≤ 0.001) was significantly higher; and the AERP (244 ± 22 vs 215 ± 27 ms; p ≤ 0.001) was prolonged in group B compared to respective pre-ablation values. There were no significant changes in the MHR (69.5 ± 7.9 vs 69.7 ± 8.7 b/min; p = 0.541) and AERP (224 ± 28 vs 225 ± 33 ms; p = 0.542) in group A. During the first four months of follow-up after ablation, the MHR gradually slowed down to pre-procedural levels in group B. The recurrence of AF (6/71 vs 7/39; p = 0.023) significantly decreased in group B relative to group A during the first 6 months after ablation, but there was no significant difference (14/71 vs 9/39; p = 0.598) at the end of the 12-month follow-up period. CONCLUSION: Patients with paroxysmal AF who develop VRs during CPVI might have a decreased recurrence of AF and accelerated MHR in the short-term.
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Ping et al. (2021) conducted an observational in paroxysmal atrial fibrillation (n=112). Vagal response during CPVI vs. No vagal response during CPVI was evaluated on Recurrence of AF during the first 6 months after ablation (p=0.023). Vagal response during circumferential pulmonary vein isolation decreased atrial fibrillation recurrence at 6 months (8.5% vs 17.9%; p=0.023), but not at 12 months (19.7% vs 23.1%; p=0.598).
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