High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation

Călburean, Paul-Adrian; Osório, Thiago Guimarães; Sorgente, Antonio; Almorad, Alexandre; Pannone, Luigi; Monaco, Cinzia; Miraglia, Vincenzo; Housari, Maysam Al; Mojica, Joerelle; Bala, Gezim; Bisignani, Antonio; Lipartiti, Felicia; Strazdas, Antanas; Ramak, Robbert; Overeinder, Ingrid; Meir, Mark La; Ströker, Erwin; Brugada, Pedro; Boveda, Serge; Paparella, Gaetano; Iacopino, Saverio; Sieira, Juan; Chierchia, Gian Battista; Asmundis, Carlo de

doi:10.1111/pace.14408

Cited by 10 publications

(11 citation statements)

References 21 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reducing overall vagosympathetic activity and minimizing imbalance between the sympathetic/parasympathetic nerve system both contributed to the prevention of AF from recurrence following catheter ablation ( 20 ). High parasympathetic tones accurately predict pulmonary vein reconnection among recurrent patients with AF receiving redo catheter ablation, no matter on vein-per-vein analysis or case-per-case analysis ( 43 ). The degree and sustained duration of parasympathetic denervation after catheter ablation were both proved related closely to AF recurrence ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis

Zhang

Liang²,

Sun³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundAtrial fibrillation (AF) has been a worldwide health issue with increasing prevalence and mortality. Recently, increasing attention has been gained to the relationship between heart rate variability (HRV) and the clinical prognosis of AF catheter ablation. We aimed to evaluate the prognostic value of HRV in AF recurrence.MethodsWe systematically searched Web of Science, PubMed, and Embase from inception until 17 August 2022 to conduct the systematic review and meta-analysis. We included the studies reporting the predictive value of HRV parameters for AF recurrence or in which HRV parameters in AF recurrence and non-recurrence groups were individually reported.ResultsFinally, we enrolled 16 studies, including 2,352 patients. Higher rMSSD could independently predict AF recurrence following catheter ablation (OR: 1.02, 95% CI: 1.00–1.04; p = 0.03). Higher HF (OR: 1.55, 95% CI: 1.05–2.28; p = 0.03) and lower LF/HF (OR: 1.12, 95% CI: 1.03–1.20; p = 0.004) could independently predict AF recurrence within 1 year. Higher SDNN (OR: 1.02, 95% CI: 101–1.02; p = 0.0006) could independently predict AF recurrence among patients with paroxysmal AF. Almost all HRV parameters within 3 days after catheter ablation and lnHF, lnLF, and rMSSD at 3 months after catheter ablation performed significant differences in AF recurrence and non-recurrence groups.ConclusionHeart rate variability, especially higher rMSSD (within short-term and long-term periods), was closely related to recurrent AF following catheter ablation, highlighting the clinical importance of HRV in the prognosis of AF following catheter ablation.

show abstract

Section: Discussionmentioning

confidence: 99%

Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis

Zhang

Liang²,

Sun³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…31,32 A recent study has showed that intensified vagal tone estimated with DC, as well as absolute power of the very-low-frequency (VLF) band and mean of the SDs of all the NN intervals for each 5 min segment (SDNNI), was observed in ablation-treated patients with reconnected PVs compared to those without reconnections. 12 It was suggested that cardiac reinnervation, especially parasympathetic reinnervation, might be an indispensable process in reconnections of PVs, presumably accounting for the higher DC postablation in AF patients with late recurrence. In the sensitivity analysis, it was interesting that patients with early recurrence appeared to have the higher DC within the first 3 days in relation to those with late recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Regarding to late recurrence occurring after a 3-month blanking period, one of the most prominent reasons is reconnection of isolated PVs that is also associated with cardiac parasympathetic hypertonicity. 11,12 Deceleration capacity (DC), an index assessing decelerationrelated heart-rate variability (HRV), is usually regarded as an indicator of parasympathetic activity when calculated in accordance with phase-rectified signal averaging (PRSA) algorithm. 13 Owing to elimination of non-periodic components in a 24-h Holter recording, DC is rarely affected by ectopic beats and artifacts, which is superior to the established HRV parameters.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of cardiac deceleration capacity in patients with atrial fibrillation after catheter ablation: A systematic review and meta‐analysis

Maimaitijiang,

Dai,

Lai

et al. 2024

Cardiovasc electrophysiol

View full text Add to dashboard Cite

IntroductionCather ablation (CA) is a well‐recognized treatment alternative for atrial fibrillation (AF) patients despite more than 20% ablation‐treated patients suffering from AF recurrence. The underlying mechanism of AF recurrence postablation is probably associated with high cardiac parasympathetic activity, which can be assessed with deceleration capacity (DC) of heart rate. Given that the relationship between DC and AF recurrence is still controversial, this systematic review and meta‐analysis was performed to investigate the characteristics of DC in patients with and without AF recurrence, evaluating the prognostic value of DC in AF patients after CA.MethodsA literature search was systematically performed in the Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases until October 01, 2023. The observational studies reporting either the pre‐ and postablation DC in both recurrence and non‐recurrence groups or the ratios based on DC for predicting AF recurrence were mainly included. Weighted mean differences (WMD) or odds ratios (OR) based on DC would be calculated with a random‐effect model, if heterogeneity estimated with the I2 index and Q statistic was significant (I2 > 50% or p < .05); otherwise, a fixed‐effect model would be utilized.ResultsA total of eight observational studies involving 914 AF patients treated with radiofrequency or cryoballoon ablation were included in this study. Ablation‐treated patients with AF recurrence had the higher DC postablation in relation to those without recurrence (WMD, 1.00; 95% confidence interval [CI], 0.33–1.67; p < .01), which was present up to 3 months of follow‐up (WMD, 1.54; 95% CI, 1.11–1.96; p < .01), whereas there was no statistical significance in DC before ablation between recurrence and non‐recurrence groups (WMD, 0.34; 95% CI, −0.12 to 0.79; p = .15). The high DC postablation was a risk factor for AF recurrence in ablation‐treated patients (OR, 2.17; 95% CI, 1.44–3.25; p < .01).ConclusionThe high DC postablation was associated with the risk of AF recurrence, suggesting that DC may act as a prognostic indicator in AF patients treated with CA.

show abstract

“…Moreover, high deceleration capacity (DC) at ECG Holter monitoring could predict AF recurrence after PVI with CB-A ( 59 ). Interestingly, high parasympathetic tone, expressed by DC and other surrogate markers, could predict not only AF recurrence but also PV reconnection ( 61 ). Right-sided only PVs reconnection was associated with higher parasympathetic tone than left-sided only PVs reconnection.…”

Section: Autonomic Denervation During Cryoballoon Catheter Ablation F...mentioning

confidence: 99%

Cryoballoon ablation for atrial fibrillation: Effects on neuromodulation

Monte

Pannone

Bisignani

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Pulmonary vein isolation (PVI) represents the mainstay of atrial fibrillation (AF) ablation, and PVI with cryoballoon catheter (CB) ablation (CB-A) has proven to be as effective and safe as radiofrequency ablation (RF-A). Although AF is initiated by triggers arising from the pulmonary veins (PV) and non-PV foci, the intrinsic cardiac nervous system (ICNS) plays a significant role in the induction and maintenance of AF. The ICNS is an epicardial neural system composed of ganglionated plexi (GPs) and a complex network of interconnecting neurons. In the left atrium, the major GPs are located in proximity to the PV-left atrial junction. Vagal reactions have been described as markers of autonomic modulation during PVI with both RF-A and CB-A. The occurrence of neuromodulation during PVI with CB-A may be explained by both the anatomical relationship between the GPs and the PVs and the characteristics of the CB. Due to the CB/PV size mismatch, the CB creates a wide ablation area that extends from the PV ostium toward the antrum, possibly including the GPs. Although targeted GPs ablation, as a supplemental strategy to PVI, has been associated with a better AF outcome in patients undergoing RF-A, the additional clinical benefit of neuromodulation during PVI with CB-A remains a matter of debate. In this review, we provide an overview of the anatomy of the ICNS, the relationship between the ICNS and AF pathophysiology, and the current evidence on the clinical relevance of neuromodulation during PVI with CB-A.

show abstract

High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation

Cited by 10 publications

References 21 publications

Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis

Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis

Prognostic value of cardiac deceleration capacity in patients with atrial fibrillation after catheter ablation: A systematic review and meta‐analysis

Cryoballoon ablation for atrial fibrillation: Effects on neuromodulation

Contact Info

Product

Resources

About