Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Cardiovasc Electrophysiol. 2024 Oct;35(10):1997-2005. doi: 10.1111/jce.16401. Epub 2024 Aug 12.
Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation-induced CANS changes, as assessed via variations in heart rate (HR) postablation.
Consecutive paroxysmal AF patients undergoing first-time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12-month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24-h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV-SVC distance).
A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV-SVC distance (odds ratio [OR]: 0.49, CI: 0.34-0.71, p value < .001), and age (OR: 0.94, CI: 0.89-0.98, p value = .003).
Thermal balloon-based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV-SVC distance.
热消融心房颤动（AF）对心脏自主神经系统（CANS）具有附加的治疗作用。这种作用主要在消融右上肺静脉（RSPV）时被报道，通过调节右前神经节丛（RAGP）来实现，后者包含位于RSPV 和上腔静脉（SVC）之间的心外膜脂肪垫内窦房结的副交感神经支配。然而，消融后对神经调节的反应存在变异性，在一些患者中几乎没有效果。我们的目的是评估热消融诱导的 CANS 变化的临床和解剖学预测因子，通过消融后心率（HR）的变化来评估。
连续纳入在 12 个月内接受冷冻球囊（CB）或射频球囊（RFB）首次行肺静脉隔离的阵发性 AF 患者，并进行术前心脏计算机断层扫描（CT）检查。采集窦性心律下消融前和 24 小时的心电图并进行分析以评估 HR。通过 CT 进行解剖学评估，包括测量 SVC 和 RSPV 口之间的最短距离（RSPV-SVC 距离）。
共纳入 97 例患者（CB 组，n=50 例；RFB 组，n=47 例），两组患者的基线特征相似。共有 37 例（38.1%）患者在消融后出现显著的 HR 增加（ΔHR≥15 bpm），两种热消融技术之间患者数量无差异（CB 组 19 例[51%]，RFB 组 18 例[49%]）。HR 增加的独立预测因子是 RSPV-SVC 距离（比值比[OR]：0.49，95%置信区间[CI]：0.34-0.71，p 值<.001）和年龄（OR：0.94，95%CI：0.89-0.98，p 值=.003）。
基于热球囊的 PV 隔离通过对 RAGP 的影响来影响 CANS，特别是在年轻患者和 RSPV-SVC 距离较短的患者中。
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