Effect of Cryoballoon Ablation vs. Radiofrequency Ablation on Left Atrial Ganglionated Plexi in Patients with Atrial Fibrillation

Background: Cryoballoon ablation for pulmonary vein isolation (PVI) is efficacious for the treatment of paroxysmal atrial fibrillation (PAF). However, the effectiveness of cryoballoon-based PVI on the left atrial (LA) ganglionated plexi (GPs) has not been reported. Therefore, we conducted a retrospective study in which we compared vagal responses during cryoballoon ablation (CBA) or radiofrequency ablation (RFA) for PVI. Methods: The study included 49 patients with AF (23 women and 26 men, 62.7 ± 10.9 years of age) who were symptomatic, despite treatment with 1 or more antiarrhythmic drugs, and thus underwent PVI by means of CBA or RCA. High-frequency stimulation (20 Hz, 25 mA, 10 ms) was performed at 5 major LA GP sites before and after PVI in 18 patients treated by RFA and in 31 patients treated by CBA, and vagal responses and treatment outcomes were compared between the 2 patient groups. Results: Elimination of the vagal responses was similar between the 2 groups. At a median follow-up of 7 (3-9) months, AF recurred in 1 of the 31 (3.2%) patients treated with CBA and in 2 of the 18 (11.1%) patients treated with RFA ( p = 0.3017). Conclusion: The efficacy of CBA for AF may be due in part to ablation of the LA GPs that occurs during PVI.