High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

Paul-Adrian Călburean, Thiago Guimarães Osório, Juan Sieira, Erwin Ströker, Riccardo Maj, Muryo Terasawa, Alessandro Rizzo, Gianluca Borio, Oriana Scala, Alessio Galli, Pedro Brugada, Gian-Battista Chierchia, Carlo De Asmundis

Research output: Contribution to journalArticle

Abstract

PURPOSE: High parasympathetic nervous system (PNS) activity is accurately reflected by deceleration capacity (DC) and is involved in atrial fibrillation (AF) recurrence after catheter ablation procedure. When compared with initial catheter ablation procedure, repeated procedures for AF recurrence are followed by a lower success rates, estimated at 50%. Our objective was to evaluate the impact of PNS activity assessed by DC measured before repeated procedure on AF recurrence after repeated procedure.

METHODS: Consecutive patients who underwent an initial catheter ablation procedure for pulmonary vein (PV) isolation and a repeated catheter ablation procedure for AF recurrence were selected. Additional 24-h ambulatory electrocardiographic recording between procedures for DC measurement was required for inclusion. A total of 110 patients were included. Seventy-two patients underwent cryoballoon (CB) ablation and 38 patients underwent radiofrequency (RF) ablation as initial procedure, while all patients underwent RF ablation as repeated procedure.

RESULTS: DC was higher in cases with right-sided PV reconnection (p = 0.04, OR = 1.38, 95% CI = 1.08-1.78). In patients with CB ablation as initial procedure, DC was higher in patients with PV reconnection (p = 0.03, OR = 1.29, 95% CI = 1.11-1.70), and the number of reconnected PVs was higher in patients with DC ≥ 7.0 ms (median DC value used for dichotomization, p = 0.02, OR = 2.19, 95% CI = 1.10-4.37). In multivariate Cox regression, DC predicted AF recurrence after repeated ablation (p = 0.004, HR = 1.68, 95% CI = 1.35-1.82). In multivariate binary regression, DC predicted persistent AF type recurrence after repeated ablation (p = 0.01, OR = 1.50, 95% CI = 1.10-2.02).

CONCLUSIONS: DC is a novel predictor of AF recurrence and AF recurrence type after repeated catheter ablation procedure. DC may reflect the need of more intensive treatment strategies in patients with high PNS activity.

Original languageEnglish
Pages (from-to)21-29
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume60
Issue number1
Early online date7 Jan 2020
DOIs
Publication statusPublished - Jan 2021

Keywords

  • Atrial fibrillation
  • Atrial fibrillation recurrence
  • Catheter ablation
  • Deceleration capacity
  • Pulmonary vein isolation

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