Key result
Second-generation cryoballoon ablation of the right superior pulmonary vein caused the most significant acute loss in parasympathetic innervation, reducing the vagal response pause from 10251.83 ms to 1687.5 ms (p < 0.001).
Why the study?
The study was designed to evaluate each distinct pulmonary vein's contribution to acute loss in vagal innervation during second-generation cryoballoon ablation using external cardiac vagal stimulation.
Does pulmonary vein isolation with second-generation cryoballoon reduce vagal innervation in patients with paroxysmal atrial fibrillation?
Observational (n=60)
No
Does pulmonary vein isolation with second-generation cryoballoon reduce vagal innervation in patients with paroxysmal atrial fibrillation?
Second-generation cryoballoon ablation for atrial fibrillation causes significant acute loss in parasympathetic innervation, particularly after isolation of the right superior pulmonary vein.
Answers are grounded in this paper and cite their sources.
Should not alter cryoballoon PVI strategy despite acute vagal loss after RSPV isolation; leaves open impact on long-term AF recurrence.
AIMS: The purpose of this study was to evaluate the contribution in the acute loss in vagal innervation after ablation with the second generation cryoballoon (CB-A) in each distinct pulmonary vein (PV) by means of external cardiac vagal stimulation (ECVS) by positioning a catheter in the internal jugular vein in a cohort of 60 patients. METHODS: Sixty patients, 50 starting from the left superior pulmonary vein (LSPV) and 10 from the right superior pulmonary vein with symptomatic paroxysmal atrial fibrillation (PAF), having undergone ECVS before the first and after each PV ablation by means of CB-A ablation, were included. RESULTS: The ECVS performed pre-ablation provoked cardioinhibitory responses in all cases with mean pause duration of 10251.83 ms ± 2826.23 ms. At the end of the procedure, the vagal reactions (VR) were significantly diminished. Specifically, compared against the initial pause, responses were 8957.06 ± 2711.66 ms (p < 0.01) after left superior PV, 10017.36 ± 9127.0 ms (p = 0.88) after left inferior PV, 6020.16 ± 3780.709 ms (p < 0.001) after right inferior PV and 1687.5 ± 2183.7 ms (p < 0.001) after right superior PV. Noteworthy, if starting with ablation in the RSPV, VR was immediately reduced by 90.34%, 990.7 ± 379.78 ms (p < 0.001) as compared to baseline response. CONCLUSION: Although not directly targeting the ganglion plexuses, AF ablation with the CB-A causes a significant acute loss in parasympathetic innervation. The RSPV showed to be associated with the most significant reduction of acute loss in parasympathetic innervation.
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Osório et al. (2019) conducted an observational in Paroxysmal atrial fibrillation (n=60). Second-generation cryoballoon ablation vs. Baseline (pre-ablation) was evaluated on Vagal reaction pause duration to external cardiac vagal stimulation after right superior pulmonary vein ablation (p=<0.001). Second-generation cryoballoon ablation of the right superior pulmonary vein caused the most significant acute loss in parasympathetic innervation, reducing the vagal response pause from 10251.83 ms to 1687.5 ms (p < 0.001).
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