AI Article Synopsis

  • The study investigates how thermal atrial fibrillation (AF) ablation impacts the cardiac autonomic nervous system (CANS) by focusing on the effects during the ablation of the right superior pulmonary vein (RSPV) and its influence on the heart rate (HR) post-ablation.
  • Researchers evaluated 97 patients undergoing first-time thermal ablation, analyzing HR changes and anatomical factors through pre- and post-procedural electrocardiograms and cardiac CT measurements.
  • Results showed that 38.1% of patients experienced a significant HR increase after the procedure, with key predictors being the distance between the RSPV and superior vena cava (SVC) and the patient's age,

Article Abstract

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.

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Source
http://dx.doi.org/10.1111/jce.16401DOI Listing

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