AI Article Synopsis
- The study investigates the vagal response (VR) during pulmonary vein isolation (PVI) for atrial fibrillation (AF), focusing on the incidence, risk factors, and outcomes of VR when initiated from the right superior pulmonary vein (RSPV).
- A total of 702 AF patients were included, with 77 (11.0%) experiencing 81 episodes of VR, primarily in those with paroxysmal AF, and common VR symptoms included sinus arrest and bradycardia.
- Increased body mass index (BMI) and left ventricular ejection fraction (LVEF) were identified as independent risk factors for VR, but the presence of VR did not correlate with improved long-term outcomes in AF recurrence.
Article Abstract
Background: The vagal response (VR) is unavoidable during pulmonary vein isolation (PVI) for atrial fibrillation (AF). In this study, we aimed to investigate the incidence, risk factors, and clinical outcomes of VR during PVI initiated from the right superior pulmonary vein (RSPV).
Methods: Patients with AF were consecutively enrolled. PVI was initiated from the RSPV, followed by other PVs. The VR was defined as atrioventricular block (AVB), asystole, or a 50 % increase in the R-R interval.
Results: We enrolled 702 patients with AF (paroxysmal = 380, persistent = 322). Seventy-seven (11.0 %) patients developed 81 VR episodes, which were more common in paroxysmal than persistent AF (74 [19.5 %] vs. 3 [0.9 %], P < 0.001). VR manifestations in paroxysmal AF included sinus arrest in 51 (63.0 %) patients, sinus bradycardia in 26 (32.1 %), and AVB in one (1.2 %) patient. For persistent AF, VR manifested as AVB. Most VR episodes were observed in the left superior ganglionated plexi (n = 67, 82.7 %). Body mass index (BMI) ≥28.0 kg/m (odds ratio [OR] = 2.261, P = 0.005) and left ventricular ejection fraction (LVEF) ≥60.0 % (OR = 2.622, P = 0.018) were independent risk factors. Among patients with paroxysmal AF, seven (9.5 %) with VR and 34 (11.1 %) without VR had AF recurrence during a follow-up of 15.5 ± 4.6 months (P = 0.582).
Conclusions: VR occurred more often in paroxysmal AF than in persistent AF during RSPV-initiated PVI, with specific manifestations. Increased BMI and LVEF were independent risk factors. Inadvertent VR does not predict better clinical outcome.
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| http://dx.doi.org/10.1016/j.ijcard.2024.132915 | DOI Listing |
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