Vagal response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation

Qin, Mu; Liu, Xu; Jiang, Wei; Wu, Shao Hui; Zhang, Xiao Dong; Po, Sunny S.

doi:10.1016/j.ijcard.2016.02.116

Cited by 25 publications

(21 citation statements)

References 22 publications

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“…We found that the AFCA by PVAI impaired the noninvasive ANS parameters, but this effect was not found to be associated with post‐PVI AF recurrence. Complete elimination of vagal response (vagal denervation) appeared associated with reduced AF recurrence and with marked HRV changes consistent with ANS withdrawal . The HRV parameters after AFCA showed a significant parasympathetic (and sympathetic) denervation in the first 6 months, which was more prominent in patients with anatomic GP ablation and in those without AF recurrence .…”

Section: Discussionmentioning

confidence: 87%

“…Complete elimination of vagal response (vagal denervation) appeared associated with reduced AF recurrence [7][8][9] and with marked HRV changes consistent with ANS withdrawal. 8,47 The HRV parameters after AFCA showed a significant parasympathetic (and sympathetic) denervation in the first 6 months, which was more prominent in patients with anatomic GP ablation and in those without AF recurrence. 58 Oswald et al also demonstrated that CB PVAI significantly modulated the cardiac ANS, but only temporarily for up to 3 months, measured by HRV changes after ablation.…”

Section: Discussionmentioning

confidence: 99%

“…45 In these patients, vagal reactions during PVAI such as vagally mediated bradycardia or asystole are thought to reflect intrinsic cardiac ANS modulation and/or denervation. 46,47 It has been shown that AFCA increased the sinus mean HR 45 and decreased the standard deviation of RR intervals 1 week after AFCA compared with preablation values. 48 Moreover, the values for the RHR and chronotropic competence has been shown to be impaired after the maze procedures.…”

Section: Discussionmentioning

confidence: 99%

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The short‐term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation

Kuyumcu¹,

Özeke²,

Çay³

et al. 2017

Pacing Clinical Electrophis

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This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The short‐term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation

Kuyumcu¹,

Özeke²,

Çay³

et al. 2017

Pacing Clinical Electrophis

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“…Pappone et al were the first to report that complete vagal denervation, i.e., elimination of the vagal response (manifested as sinus bradycardia, asystole, atrioventricular block, or hypotension during RF application and reduced heart rate variability during follow-up) decreased the incidence of AF recurrence in patients with PAF treated by circumferential PVI 18) . Quin et al also reported that a positive RFA-induced vagal response was associated with reduced AF recurrence in patients with lone PAF 19) . Yorgun et al reported that vagal reactions (bradycardia, hypotension) during CBA were associated with decreased AF recurrence in a subgroup of patients with PAF and PerAF 20) .…”

Section: Gp Ablationmentioning

confidence: 92%

Effect of Cryoballoon Ablation vs. Radiofrequency Ablation on Left Atrial Ganglionated Plexi in Patients with Atrial Fibrillation

Takahashi

Watanabe

Okumura

et al. 2018

Nichidai Igaku Zasshi

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Background: Cryoballoon ablation for pulmonary vein isolation (PVI) is efficacious for the treatment of paroxysmal atrial fibrillation (PAF). However, the effectiveness of cryoballoon-based PVI on the left atrial (LA) ganglionated plexi (GPs) has not been reported. Therefore, we conducted a retrospective study in which we compared vagal responses during cryoballoon ablation (CBA) or radiofrequency ablation (RFA) for PVI.Methods: The study included 49 patients with AF (23 women and 26 men, 62.7 ± 10.9 years of age) who were symptomatic, despite treatment with 1 or more antiarrhythmic drugs, and thus underwent PVI by means of CBA or RCA. High-frequency stimulation (20 Hz, 25 mA, 10 ms) was performed at 5 major LA GP sites before and after PVI in 18 patients treated by RFA and in 31 patients treated by CBA, and vagal responses and treatment outcomes were compared between the 2 patient groups.Results: Elimination of the vagal responses was similar between the 2 groups. At a median follow-up of 7 (3-9) months, AF recurred in 1 of the 31 (3.2%) patients treated with CBA and in 2 of the 18 (11.1%) patients treated with RFA ( p = 0.3017).Conclusion: The efficacy of CBA for AF may be due in part to ablation of the LA GPs that occurs during PVI.

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“…Katritsis et al recently conducted a multi‐center clinical randomized controlled study and reported that circumferential pulmonary vein isolation combined with denervation at PV ostium could improve the postoperative success rate of AF patients by approximately 30%. Notably, our study also confirmed that intervention of PV ostium (including: RSPV anterior wall and LSPV apex, etc.) with radiofrequency ablation can produce significant vagal reactions manifested by sinus arrest and atrioventricular conduction delay; modification of this region can significantly decrease the postoperative recurrence rate (Figure ).…”

Section: The Relationship Between Regulated Network Of Cans and Afmentioning

confidence: 99%

The cardiac autonomic nervous system: A target for modulation of atrial fibrillation

Qin

Zeng

2019

Clinical Cardiology

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The cardiac autonomic nerve system (CANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF). In this review, we focus on the relationship between the autonomic nervous system (ANS) and the pathophysiology of AF and the potential benefit and limitations of neuromodulation in the management of this arrhythmia from eight aspects. We conclude that Activation and Remodeling of CANS involved in the initiation and maintenance of AF. The network control mechanism, innervation regions, and sympathetic/parasympathetic balance play an important role in AF substrate. And the formation of Complex Fractional Atrial Electrograms also related to CANS activity. In addition, modulating CANS function by potential therapeutic applications include ganglionated plexus ablation, renal sympathetic denervation, and low‐level vagal nerve stimulation, may enable AF to be controlled. Although the role of the ANS has long been recognized, a better understanding of the complex interrelationships of the various components of the CANS will lead to improvement of treatments for this common arrhythmia.

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Vagal response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation

Cited by 25 publications

References 22 publications

The short‐term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation

The short‐term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation

Effect of Cryoballoon Ablation vs. Radiofrequency Ablation on Left Atrial Ganglionated Plexi in Patients with Atrial Fibrillation

The cardiac autonomic nervous system: A target for modulation of atrial fibrillation

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