TY - JOUR
T1 - Distance-dependent neuromodulation effect during thermal ablation for atrial fibrillation
AU - Nakasone, Kazutaka
AU - Tanaka, Kaoru
AU - Del Monte, Alvise
AU - Della Rocca, Domenico Giovanni
AU - Pannone, Luigi
AU - Mouram, Sahar
AU - Cespón-Fernández, María
AU - Doundoulakis, Ioannis
AU - Marcon, Lorenzo
AU - Audiat, Charles
AU - Vetta, Giampaolo
AU - Scacciavillani, Roberto
AU - Overeinder, Ingrid
AU - Bala, Gezim
AU - Sorgente, Antonio
AU - Sieira, Juan
AU - Almorad, Alexandre
AU - Fukuzawa, Koji
AU - Hirata, Ken-Ichi
AU - Brugada, Pedro
AU - Sarkozy, Andrea
AU - Chierchia, Gian Battista
AU - de Asmundis, Carlo
AU - Ströker, Erwin
N1 - Publisher Copyright:
© 2024 Wiley Periodicals LLC.
PY - 2024/10
Y1 - 2024/10
N2 - Introduction: Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation-induced CANS changes, as assessed via variations in heart rate (HR) postablation. Methods: Consecutive paroxysmal AF patients undergoing first-time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12-month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24-h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV-SVC distance). Results: A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV-SVC distance (odds ratio [OR]: 0.49, CI: 0.34–0.71, p value <.001), and age (OR: 0.94, CI: 0.89–0.98, p value =.003). Conclusions: Thermal balloon-based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV-SVC distance.
AB - Introduction: Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation-induced CANS changes, as assessed via variations in heart rate (HR) postablation. Methods: Consecutive paroxysmal AF patients undergoing first-time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12-month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24-h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV-SVC distance). Results: A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV-SVC distance (odds ratio [OR]: 0.49, CI: 0.34–0.71, p value <.001), and age (OR: 0.94, CI: 0.89–0.98, p value =.003). Conclusions: Thermal balloon-based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV-SVC distance.
UR - http://www.scopus.com/inward/record.url?scp=85201046195&partnerID=8YFLogxK
U2 - 10.1111/jce.16401
DO - 10.1111/jce.16401
M3 - Article
C2 - 39135364
VL - 35
SP - 1997
EP - 2005
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
IS - 10
ER -