Pulsed field ablation of the right superior pulmonary vein prevents vagal responses via anterior right ganglionated plexus modulation

Del Monte, Alvise; Della Rocca, Domenico Giovanni; Pannone, Luigi; Vetta, Giampaolo; Cespón Fernández, María; Marcon, Lorenzo; Doundoulakis, Ioannis; Mouram, Sahar; Audiat, Charles; Zeriouh, Sarah; Monaco, Cinzia; Al Housari, Maysam; Betancur, Andrés; Mené, Roberto; Iacopino, Saverio; Sorgente, Antonio; Bala, Gezim; Ströker, Erwin; Sieira, Juan; Almorad, Alexandre; Sarkozy, Andrea; Boveda, Serge; de Asmundis, Carlo; Chierchia, Gian-Battista

doi:10.1016/j.hrthm.2024.01.040

Cited by 11 publications

(1 citation statement)

References 25 publications

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“…Seven patients (6.7%) experienced transient conduction disturbances (in the sinus node but also the atrioventricular node). This phenomenon could be due to ganglionated plexi stimuli, as it is frequently observed during PFA-based PVI, 20 even though direct nodal stunning cannot be excluded.…”

Section: Discussionmentioning

confidence: 95%

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation

Ollitrault,

Chaumont,

Font

et al. 2024

Europace

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Aims Superior vena cava (SVC) isolation during atrial fibrillation (AF) catheter ablation is limited by the risk of collateral damage to the sinus node and/or the phrenic nerve. Due to its tissue-specificity, we hypothesized the feasibility and safety of pulsed-field ablation (PFA)-based SVC isolation. Methods and results A hundred and five consecutive patients undergoing PFA-based AF catheter ablation were prospectively included. After pulmonary vein isolation (± posterior wall isolation and electrical cardioversion), SVC isolation was performed using a standardized workflow. Acute SVC isolation was achieved in 105/105 (100%) patients after 6 ± 1 applications. Transient phrenic nerve stunning occurred in 67/105 (64%) patients but without phenic nerve palsy at the end of the procedure and at hospital discharge. Transient high degree sinus node dysfunction occurred in 5/105 (4.7%) patients, with no recurrence at the end of the procedure and until discharge. At the 3-month follow-up visit, no complication occurred. Conclusion SVC isolation using a pentaspline PFA catheter is feasible and safe.

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Section: Discussionmentioning

confidence: 95%

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation

Ollitrault,

Chaumont,

Font

et al. 2024

Europace

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Short-term deceleration capacity: a novel non-invasive indicator of parasympathetic activity in patients undergoing pulmonary vein isolation

Zarębski,

Futyma

2024

J Interv Card Electrophysiol

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Background Subtypes of atrial fibrillation (AF) can differ, and exact mechanisms in which patients benefit from the pulmonary vein isolation (PVI) remain not fully understood. During PVI, vagal innervation of the heart may also be affected. Thus, non-invasive methods of intraprocedural assessment of such PVI impact are sought. Methods From 1-minute ECG recordings performed before and after PVI, we investigated short-term deceleration capacity (ST-DC) and short-term heart rate variability (ST-HRV) to determine their potential as indicators of parasympathetic activity before and after ablation. Results In 24 consecutive patients with paroxysmal AF included in the study, there were a significant differences in ST-DC and ST-HRV parameters measured before and after PVI. After 3 months, patients with baseline ST-DC ≥ 7.5 ms were less likely to experience AF recurrence when compared to patients with baseline ST-DC < 7.5 ms (0% vs 31%, p = 0.0496). There were no differences in AF recurrence after 12 months of follow-up (36% vs 38%, p = 0.52). Conclusion PVI leads to significant changes in ST-DC and ST-HRV, and these parameters can serve as indicators of vagal denervation after AF ablation. Patients with more prominent baseline ST-DC are less likely to experience AF recurrence during the post-PVI 3-month blanking period. Graphical Abstract

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Managing vagal responses induced by pulsed field ablation: Go right first?

Santangeli,

Rosso,

Pachon

2024

Heart Rhythm

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Pulsed field ablation of the right superior pulmonary vein prevents vagal responses via anterior right ganglionated plexus modulation

Cited by 11 publications

References 25 publications

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation

Short-term deceleration capacity: a novel non-invasive indicator of parasympathetic activity in patients undergoing pulmonary vein isolation

Managing vagal responses induced by pulsed field ablation: Go right first?

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