Abigail Louise D Te1, Li-Wei Lo2, Yenn-Jiang Lin3, Shih-Lin Chang3, Yu-Feng Hu3, Fa-Po Chung3, Ta-Chuan Tuan3, Tze-Fan Chao3, Jo-Nan Liao3, Yao-Ting Chang4, Chin-Yu Lin4, Shinya Yamada4, Ting-Yung Chang4, Simon Salim4, Minh Quang Hoang4, Ting-Chun Huang4, Shih-Ann Chen3. 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; HB Calleja Heart and Vascular Institute, St. Luke's Medical Center, Quezon City, Philippines. 2. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: gyrus@ms65.hinet.net. 3. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Vasovagal responses (VR) encountered during radiofrequency pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF) suggest ablation of the atrial tissue subjacent to the ganglionic plexi (GP) and confer durability of PVI. OBJECTIVE: We hypothesized that VR during cryoballoon PVI (CB-PVI) in PAF can predict mid-term AF recurrence. METHODS: We enrolled 39 patients who underwent PVI using 2nd generation cryoballoon for PAF from November 2014 to July 2016. We evaluated the long term outcomes for those who had VR during index procedure. RESULTS: A total of 39 patients (76% male, mean age 57 ± 9 years) underwent CB-PVI for PAF and 66.67% (26/39) had VR. VR was frequently observed in the LSPV (100%), followed by RSPV (64%), LIPV (60%), and less frequently, RIPV (28%). Overall, the mean difference in the HR and SBP, and the relative differences in the HR and SBP were observed during CB-PVI in the LSPV (mean difference in HR, p < 0.001; mean difference in SBP, p < 0.001; relative difference in HR, p < 0.001); relative difference in SBP, p < 0.001). After PVI, 22/26 (84.62%) and 5/13 (38.46%) of patients in the VR and NVR group, respectively, maintained SR at 14 ± 6 months follow-up. The Kaplan-Meier analysis showed statistical difference in favor of patients with VR during CB-PVI (log rank p < 0.01) with a better mid-term outcome. CONCLUSION: In a small cohort of patients, VR during CB-PVI in PAF is a surrogate marker for ablation of atrial tissue subjacent to the GP and predicts a favorable mid-term outcome for AF recurrence.
BACKGROUND: Vasovagal responses (VR) encountered during radiofrequency pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF) suggest ablation of the atrial tissue subjacent to the ganglionic plexi (GP) and confer durability of PVI. OBJECTIVE: We hypothesized that VR during cryoballoon PVI (CB-PVI) in PAF can predict mid-term AF recurrence. METHODS: We enrolled 39 patients who underwent PVI using 2nd generation cryoballoon for PAF from November 2014 to July 2016. We evaluated the long term outcomes for those who had VR during index procedure. RESULTS: A total of 39 patients (76% male, mean age 57 ± 9 years) underwent CB-PVI for PAF and 66.67% (26/39) had VR. VR was frequently observed in the LSPV (100%), followed by RSPV (64%), LIPV (60%), and less frequently, RIPV (28%). Overall, the mean difference in the HR and SBP, and the relative differences in the HR and SBP were observed during CB-PVI in the LSPV (mean difference in HR, p < 0.001; mean difference in SBP, p < 0.001; relative difference in HR, p < 0.001); relative difference in SBP, p < 0.001). After PVI, 22/26 (84.62%) and 5/13 (38.46%) of patients in the VR and NVR group, respectively, maintained SR at 14 ± 6 months follow-up. The Kaplan-Meier analysis showed statistical difference in favor of patients with VR during CB-PVI (log rank p < 0.01) with a better mid-term outcome. CONCLUSION: In a small cohort of patients, VR during CB-PVI in PAF is a surrogate marker for ablation of atrial tissue subjacent to the GP and predicts a favorable mid-term outcome for AF recurrence.
Authors: Alvise Del Monte; Luigi Pannone; Antonio Bisignani; Thiago G Osório; Saverio Iacopino; Gian-Battista Chierchia; Carlo de Asmundis Journal: Front Cardiovasc Med Date: 2022-07-28