March 11, 2017Pacing and Clinical Electrophysiology
Prophylactic Atropine Administration Prevents Vasovagal Response Induced by Cryoballoon Ablation in Patients with Atrial Fibrillation
Key result
Prophylactic atropine linked to ~64% fewer marked vagal responses during cryoballoon ablation vs reactive use.
- P<0.01
- n=25
Why the study?
Cryoballoon ablation of pulmonary vein ostia often induces a vagal response causing hemodynamic impairment in patients with atrial fibrillation.
Does prophylactic intravenous atropine prevent vasovagal responses in patients with paroxysmal atrial fibrillation undergoing cryoballoon ablation?
Comparison
Prophylactic intravenous atropine before cryoballoon deflation vs atropine after onset of hemodynamic variation
Design
Prospective cohort study
Authors
Discussion
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Implication
Prophylactic atropine was associated with fewer vagal responses; leaves open need for randomized trials before routine adoption.
Structured PICO
Does prophylactic intravenous atropine prevent vasovagal responses in patients with paroxysmal atrial fibrillation undergoing cryoballoon ablation?
P
Population
25 patients with paroxysmal atrial fibrillation undergoing cryoballoon ablation.
I
Intervention
1 mg of intravenous atropine administered prophylactically before deflation of the cryoballoon
C
Comparator
Atropine administered only after the onset of hemodynamic variation (decrease in heart rate and/or blood pressure)
O
Outcome
Rate of marked vagal responses (hemodynamic variations requiring supportive care)safety
Main Result
Absolute Event Rate: 33.3% vs 92.3%
p-value: p=<0.01
Prophylactic administration of 1 mg intravenous atropine before cryoballoon deflation significantly reduces the incidence of marked vasovagal responses during ablation for paroxysmal atrial fibrillation.
Cite This Study
Sun et al. (2017) studied Paroxysmal atrial fibrillation (n=25). Prophylactic intravenous atropine vs. Atropine only after the onset of hemodynamic variation was evaluated on Marked vagal responses (p=<0.01). Prophylactic administration of 1 mg intravenous atropine significantly reduced the rate of marked vagal responses during cryoballoon ablation compared to reactive administration (33.3% vs 92.3%; P<0.01).