Pachon-M Jose Carlos, Pachon-M Enrique I, Santillana-P Tomas G, Lobo Tasso J, Pachon Carlos Thiene C, Pachon-M Juan Carlos, Pachon Maria Zelia C, Clark John
Sao Paulo University (USP), Juquis St, 204/41-A, Indianopolis, Sao Paulo, 04081010, Brazil.
Sao Paulo Heart Hospital (HCor), Sao Paulo, Brazil.
J Interv Card Electrophysiol. 2025 Mar;68(2):293-306. doi: 10.1007/s10840-025-02007-w. Epub 2025 Feb 13.
Currently, there is no reliable endpoint for the conclusion of atrial fibrillation (AF) ablation. Atrial burst pacing and/or isoproterenol challenge are poor diagnostic tools. A newly proposed vagal AF induction test (VAFIT) uses effective atrial refractory period measurement, simultaneously with extra-cardiac vagal stimulation (ECVS) to study AF inducibility pre- and post-ablation. This is a prospective study in patients submitted to radiofrequency catheter pulmonary vein isolation (PVI) plus cardioneuroablation (CNA) evaluating the VAFIT result before and at the end of the procedure with AF recurrence.
Prospective study of 142 patients, 57.5 (48.9-70.2) years old, 71% males, with symptomatic AF (79.6% paroxysmal/20.4% persistent), left atrium diameter of 38.0 (35.0-41.2) mm, and left ventricular ejection fraction of 63.0 (62.0-68.2). VAFIT was considered positive or negative depending on whether AF induction occurred. It was performed at baseline and after PVI + CNA, with a single atrial extra stimulus during ECVS (5 s/50 Hz/1 V/kg up to 70 V/pulse width = 50 µs). Patients were followed for a median of 15.0 (7.0-20.0) months. The association of VAFIT-positive status at the end of the procedure with AF recurrence was investigated by univariate and multivariate Cox regression analysis.
Pre-ablation VAFIT was positive in all cases and became negative in 62.9% of patients. AF recurrence: 18.7% in VAFIT-positive and 5.6% in VAFIT-negative patients (p = 0.012). VAFIT-positivity was associated with AF recurrence (HR 4.56 (1.37-15.23, p = 0.014).
A VAFIT-positive status following PVI + CNA was strongly and independently associated with AF recurrence. VAFIT negative status reduced 4.5 times the post-ablation AF recurrence. It remains to be investigated in randomized studies whether achieving VAFIT-negativity at the end of the procedure, as demonstrated in this study, would lead to better clinical outcomes.
目前，房颤（AF）消融术结束时尚无可靠的终点指标。心房猝发起搏和/或异丙肾上腺素激发试验是较差的诊断工具。一项新提出的迷走神经介导房颤诱发试验（VAFIT）采用有效心房不应期测量，并同时进行心外迷走神经刺激（ECVS），以研究消融术前和术后房颤的诱发情况。这是一项针对接受射频导管肺静脉隔离术（PVI）加心脏神经消融术（CNA）患者的前瞻性研究，评估手术开始前和结束时VAFIT结果与房颤复发情况。
对142例患者进行前瞻性研究，患者年龄57.5（48.9 - 70.2）岁，男性占71%，患有症状性房颤（阵发性占79.6%/持续性占20.4%），左心房直径38.0（35.0 - 41.2）mm，左心室射血分数63.0（62.0 - 68.2）。根据是否诱发房颤，VAFIT被判定为阳性或阴性。在基线时以及PVI + CNA术后进行该试验，在ECVS期间给予单个心房额外刺激（5秒/50赫兹/1伏/千克，最高70伏/脉宽 = 50微秒）。对患者进行了中位数为15.0（7.0 -
20.0）个月的随访。通过单因素和多因素Cox回归分析研究手术结束时VAFIT阳性状态与房颤复发之间的关联。
消融术前所有病例的VAFIT均为阳性，术后62.9%的患者变为阴性。房颤复发情况：VAFIT阳性患者中为18.7%，VAFIT阴性患者中为5.6%（p = 0.012）。VAFIT阳性与房颤复发相关（风险比4.56（1.37 - 15.23），p = 0.014）。
PVI + CNA术后VAFIT阳性状态与房颤复发密切且独立相关。VAFIT阴性状态使消融术后房颤复发风险降低4.5倍。本研究表明手术结束时达到VAFIT阴性是否会带来更好的临床结局，仍有待在随机研究中进行探究。
