Key result
Starting cryoballoon ablation from right-sided pulmonary veins significantly reduced the incidence of vagal responses compared to starting from left-sided veins (9.5% vs 61.5%, P=0.0002).
Why the study?
Does starting cryoballoon ablation from the right-sided pulmonary veins reduce vagal responses and HRV changes compared to starting from the left-sided pulmonary veins in patients with paroxysmal AF?
Observational (n=54)
Does starting cryoballoon ablation from the right-sided pulmonary veins reduce vagal responses and HRV changes compared to starting from the left-sided pulmonary veins in patients with paroxysmal AF?
Starting cryoballoon ablation from the right pulmonary veins prevents excessive vagal responses and autonomic tone changes compared to starting from the left pulmonary veins.
Answers are grounded in this paper and cite their sources.
May support right-first cryoballoon sequence to limit vagal responses; leaves open confirmation in randomized trials.
Aims: Vagal responses such as marked bradycardia or a rapid blood pressure decrease are often observed during pulmonary vein (PV) isolation of atrial fibrillation (AF) using a cryoballoon (CB). However, the relationship between the marked vagal response and change in the heart rate variability (HRV) as a marker of the autonomic tone is not well understood. Methods and results: Fifty-four paroxysmal AF patients underwent CB ablation. The CB ablation was started from the right sided PVs in 25 patients (R group) and left sided PVs in 29 (L group). The HRV and haemodynamic status during the procedure were analysed. A vagal response was observed in 16 L group patients (61.5%) during the ablation of the different PVs (RSPV:1, RIPV:5, LSPV:15, LIPV:5), while it was observed in only 2 R group patients (9.5%) (RSPV:0, RIPV:0, LSPV:1, LIPV:1) (P = 0.0002). The HRV in the L group was significantly higher than that in the R group just after the CB ablation especially for the left sided PVs (L group vs. R group, total power of the HRV, median; RSPV, 11184.7 vs. 4360.0, P = 0.21; RIPV, 9044.3 vs. 2115.1, P = 0.01; LSPV, 21186.0 vs. 1314.2, P = 0.0002; LIPV 10265.9 vs. 1236.2, P = 0.0007). Conclusion: A marked increase in the HRV parameters was observed just after the CB ablation. An initial CB ablation of the right PVs decreased the change in the autonomic tone during the right PV ablation and subsequent left PV ablation. It prevented an excessive vagal response during the CB ablation and might be a safe procedure.
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Mori et al. (2017) conducted an observational in paroxysmal atrial fibrillation (n=54). Cryoballoon ablation starting from right-sided pulmonary veins vs. Cryoballoon ablation starting from left-sided pulmonary veins was evaluated on Vagal response during ablation (p=0.0002). Starting cryoballoon ablation from right-sided pulmonary veins significantly reduced the incidence of vagal responses compared to starting from left-sided veins (9.5% vs 61.5%, P=0.0002).
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