Bezold‐Jarisch‐Like Reflex During Radiofrequency Ablation of the Pulmonary Vein Tissues in Patients with Paroxysmal Focal Atrial Fibrillation

Tsai, Chin‐Feng; Chen, Shih‐Ann; Tai, Ching‐Tai; Chiou, Chuen‐Wang; Prakash, Varsha; Yu, Wen‐Chung; Hsieh, Ming‐Hsiung; Ding, Yu‐An; Mei, Chao

doi:10.1111/j.1540-8167.1999.tb00638.x

Cited by 70 publications

(37 citation statements)

References 18 publications

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“…17 In another study, 10 transient autonomic dysfunction was observed after focal PV ablation in 37 patients, and in 6 of them, vagal reflexes were elicited but not deliberately ablated; however, there were no differences in HRV or recurrences between those with and without reflexes. This may represent methodological differences in the ablation procedure or the smaller scale of these studies.…”

Section: Parasympathetic Modification and Recurrence Of Af After Cpvamentioning

confidence: 99%

“…Previous studies have demonstrated parasympathetic nerve terminals in the PV area, and the incidence of ablationinduced bradycardia-hypotension response was higher in PV areas than with ablation of other atrial tissues. [17][18][19][20] Hsieh et al 10 reported severe bradycardia and hypotension in 6 of 37 patients undergoing focal PV ablation. In their study, the ablation site was inside the left superior PV (4 patients) or inside the right superior PV (2 patients).…”

Section: Location and Abolition Of Vagal Reflexesmentioning

confidence: 99%

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Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation

Pappone¹,

Santinelli²,

Manguso³

et al. 2004

Circulation

876

360

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Background-There are no data to evaluate the relationship between autonomic nerve function modification and recurrent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA). This study assesses the incremental benefit of vagal denervation by radiofrequency in preventing recurrent AF in a large series of patients undergoing CPVA for paroxysmal AF. Methods and Results-Data were collected on 297 patients undergoing CPVA for paroxysmal AF. Abolition of all evoked vagal reflexes around all pulmonary vein ostia was defined as complete vagal denervation (CVD) and was obtained in 34.3% of patients. Follow-up ended at 12 months. Heart rate variability attenuation, consistent with vagal withdrawal, was detectable for up to 3 months after CPVA, particularly in patients with reflexes and CVD, who were less likely to have recurrent AF than those without reflexes (Pϭ0.0002, log-rank test). Only the percentage area of left atrial isolation and CVD were predictors of AF recurrence after CPVA (PϽ0.001 and Pϭ0.025, respectively). Conclusions-This study suggests that adjunctive CVD during CPVA significantly reduces recurrence of AF at 12 months.

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Section: Parasympathetic Modification and Recurrence Of Af After Cpvamentioning

confidence: 99%

Section: Location and Abolition Of Vagal Reflexesmentioning

confidence: 99%

Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation

Pappone¹,

Santinelli²,

Manguso³

et al. 2004

Circulation

876

360

View full text Add to dashboard Cite

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“…10 Thereafter, we also decreased the maximal temperature to 50°C to 55°C during the following energy applications. The ablation end point was total elimination or marked reduction (Ͻ50% of the initial amplitude) of ectopic focus amplitude.…”

Section: Radiofrequency Catheter Ablationmentioning

confidence: 99%

Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava

Tsai¹,

et al. 2000

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Background-The superior vena cava (SVC) has cardiac musculature extending from the right atrium. However, no previous study in humans has given details regarding the ectopic foci that initiate paroxysmal atrial fibrillation (PAF), which may originate from the SVC. Methods and Results-A total of 130 patients with frequent attacks of PAF initiated by ectopic beats were included. Eight patients (6%) had spontaneous AF initiated by a burst of rapid ectopic beats from the SVC (located 19Ϯ7 mm above the junction of the SVC and right atrium), which was confirmed by multiplane angiographic and intracardiac echocardiographic visualization and was marked by a sharp SVC potential preceding atrial activity. During initial repetitive discharges, the group with SVC ectopy had a higher incidence of intravenous conduction block than the group with pulmonary vein ectopy (75% versus 37%; Pϭ0.03). The activation time of the earliest intracardiac ectopic activities relative to ectopic P wave onset was significantly shorter in the SVC ectopy than the pulmonary vein ectopy group (37Ϯ15 versus 84Ϯ32 ms; PϽ0.001). After 5Ϯ3 applications of radiofrequency energy, AF was eliminated. SVC angiography after ablation revealed a local indentation of the venous wall in one patient. Two patients manifested coexisting sinus rhythm and a "focal" fibrillating activity confined inside the SVC after radiofrequency ablation. During a follow-up period of 9Ϯ3 months, all 8 patients were free of antiarrhythmic drugs, without tachycardia recurrence or symptoms of SVC obstruction. Conclusions-Ectopic beats initiating PAF can originate from the SVC. A radiofrequency current delivered to eliminate these ectopies is a highly effective and safe way to prevent PAF. (Circulation. 2000;102:67-74.)

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“…Recently, RF catheter ablation of pulmonary veins (PVs) has been demonstrated to cure focal atrial fibrillation (AF). [7][8][9][10] However, transient sinus bradycardia, sinus arrest, and hypotension have been reported as complications during focal ablation of PVs, and thermal stimulation of vagus nerve fibers might play an important role in these complications. 9 Therefore, the purpose of the present study was to evaluate the effects of focal PVs ablation on autonomic function by using HRV.…”

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confidence: 99%

Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

et al. 1999

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Background-Transient sinus bradycardia and hypotension have been reported as complications during radiofrequency (RF) ablation of focal atrial fibrillation (AF) originating from pulmonary veins (PVs). This study used heart rate variability (HRV) to evaluate the effects of focal PVs ablation on autonomic function. Methods and Results-Thirty-seven patients with paroxysmal AF were referred for ablation. The study group included 30 patients who underwent transseptal ablation of PVs, and the control group included 7 patients who underwent the transseptal procedure without ablation. The mean sinus rate and time-domain (standard deviation of RR intervals and root-mean-square of differences of adjacent RR intervals) and frequency-domain (low frequency, high frequency, and low-frequency/high-frequency ratio) analyses of HRV were obtained by use of 24-hour Holter monitoring before and 1 week, 1 month, and 6 months after ablation. All the triggering points of AF were from PVs, and they were successfully ablated. Severe bradycardia and hypotension were noted during ablation of PVs in 6 patients (group IA); 24 patients without the above complication belonged to group IB. Compared with preablation values, a significant increase in mean sinus rate and low-frequency/high-frequency ratio and a significant decrease in standard deviation of RR intervals, root-mean-square of differences of adjacent RR intervals, low frequency, and high frequency were noted in groups IA and IB patients 1 week after ablation. The changes in HR and HRV recovered spontaneously in the 2 subgroups by 1 month later. These parameters of HRV did not change in the control group after the transseptal procedure. Conclusions-Transient autonomic dysfunction with alterations in HR and HRV occurred after ablation of focal AF

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Bezold‐Jarisch‐Like Reflex During Radiofrequency Ablation of the Pulmonary Vein Tissues in Patients with Paroxysmal Focal Atrial Fibrillation

Abstract: RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia-hypotension responses. The Bezold-Jarisch-like reflex might be the underlying mechanism.

Cited by 70 publications

References 18 publications

Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation

Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation

Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava

Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

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