B-PO03-112 ACUTE CHANGE IN PARASYMPATHETIC CARDIAC INNERVATION AFTER PULMONARY VEIN ISOLATION BY PULSE-FIELD AND RADIOFREQUENCY ENERGY

Abstract Background In patients with atrial fibrillation (AF), pulmonary vein isolation (PVI) by radiofrequency (RF) energy is associated with a significant change of cardiac autonomic regulations due to collateral ganglionic plexi ablation. Pulse-field (PF) ablation energy presumably spares neural tissue. Purpose We compared the effect of PVI by PF and RF energy on cardiac autonomic function. Methods A study enrolled 23 patients who underwent PVI in general anaesthesia. In 12 patients, a novel lattice-tip catheter and PF energy were used for ablation while 11 patients were ablated using a conventional irrigated-tip catheter and RF energy. The response of the sinus node (SAN) and atrioventricular node (AVN) to extracardiac high-frequency vagal stimulation (ECVS) was tested before and after PVI (via right internal jugular vein; stimulation frequency of 50 Hz; pulse width of 0.05 ms; output of 1 V/kg (<70V); train duration of 5 s). Results At baseline, physiological massive response to ECVS (sinus arrest and/or AV block) was demonstrated in the majority of patients. After PVI, complete loss of autonomic response of the SAN in 11/11 (100%) and 3/12 (25%) patients (p=0.003), and the AVN in 9/11 (82%) and 3/12 (25%) patients (p=0.01) was observed in RF and PF groups, respectively. The figure shows the maximum duration of the pause in sinus rhythm (maximum P-P interval) and AVN block (maximum R-R interval during atrial pacing) induced by ECVS after PVI. Conclusion Cardiac vagal response is preserved in a considerable proportion of AF patients after PF ablation which is in contrast with a significantly stronger effect of RF energy. This may influence the clinical outcome of AF ablation procedures. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Institute for Clinical and Experimental Medicine, Prague

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B-AB06-03 PRECLINICAL ASSESSMENT OF THE FEASIBILITY, SAFETY AND LESION DURABILITY OF A NOVEL “SINGLE-SHOT” PULSE FIELD ABLATION CATHETER FOR PULMONARY VEIN ISOLATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.038 ◽

2021 ◽

Vol 18 (8) ◽

pp. S10-S11

Author(s):

Jacob S. Koruth ◽

Iwanari Kawamura ◽

Srinivas R. Dukkipati ◽

William Whang ◽

Mohit Turagam ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Pulse Field ◽

Single Shot ◽

Ablation Catheter

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Effects of pulse field and radiofrequency pulmonary vein isolation on parasympathetic cardiac innervation

EP Europace ◽

10.1093/europace/euab116.242 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

P Peichl ◽

D Wichterle ◽

P Stojadinovic ◽

R Cihak ◽

H Nakagawa ◽

...

Keyword(s):

Pulmonary Vein ◽

Recurrence Rate ◽

Pulmonary Vein Isolation ◽

Study Groups ◽

High Energy ◽

Pulse Field ◽

Autonomic Nerves ◽

Short Term ◽

Parasympathetic Innervation ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): IKEM Background Pulmonary vein isolation (PVI) is an established treatment modality for patients with atrial fibrillation (AF). PVI performed by radiofrequency (RF) energy results in parasympathetic denervation of the heart by collateral ganglionic plexi ablation. Pulse field (PF) is a novel nonthermal energy source for PVI that selectively ablates atrial myocardium while preserving cardiac autonomic nerves, which may affect the outcome after PVI. Purpose The study compared the effect of PVI between RF and PF ablation on cardiac autonomic function and a short-term AF recurrence rate. The resting heart rate (HR) was evaluated as a simple index of sinus nodal parasympathetic innervation. Methods We investigated 45 patients (aged 64 ± 7 years, 4 women) who underwent PVI by novel three-dimensional electroanatomical mapping/ablation system (lattice electrode ablation system). PVI was performed by either high-energy RF (n = 21) or PF (n = 24) energy using the identical ablation catheter. Resting HR assessed by standard ECG was recorded the day before the procedure and at the 3-month visit. Arrhythmia recurrences were analysed by 24-Holter at the 3-month visit. Results All PVs were acutely isolated in all patients. The HR data are shown in the Table. The baseline HR did not differ between both groups. A significant increase in HR was observed only in the RF ablation subgroup. The between-group difference remained significant even after adjustment for age, gender, and baseline HR. There was no difference in arrhythmia recurrences at the 3-month visit between study groups. Conclusions Parasympathetic denervation effects on HR after the PF ablation are virtually absent. Comparable AF recurrence rate at 3-month visit after RF and PF ablation suggests that preservation of autonomic innervation has no impact on AF recurrence during short-term follow-up. Table RF PVI (n = 21) PF PVI (n = 24) P Baseline HR (bpm) 60.0 ± 7.1 63.8 ± 9.4 n.s. HR change - 3-month visit (bpm) 14.4 ± 6.9 0.3 ± 8.6 P <0.001 Arrhythmia recurrences 3/21 (14%) 2/24 (8%) n.s.

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Abstract 2754: Pulmonary Vein Isolation Using Irrigated vs. Conventional 4-mm Tip Catheters- Do Short and Long-Term Outcomes Differ?

Circulation ◽

10.1161/circ.118.suppl_18.s_772 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ganesh S Kamath ◽

Harikrishna Makani ◽

Jorge Silva Enciso ◽

Sunil Kumar ◽

Suneet Mittal ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Clinical Investigation ◽

Study Cohort ◽

Radiofrequency Energy ◽

Entire Study ◽

Number Of Patients ◽

Significant Difference ◽

Initial Procedure ◽

Short And Long Term

Open saline-irrigated tip ablation catheters have largely supplanted standard 4 mm tip ablation catheters for pulmonary vein isolation (PVI) of atrial fibrillation (AF), based on the assumption that the procedure is safer and more efficacious. However, outcomes after procedures that use identical techniques but different radiofrequency ablation catheters have not been compared. We studied 432 consecutive patients (age 57 ± 11 yrs) with AF (duration 7.9 ± 6.1 yrs) who underwent PVI; 320 (74 %) using a conventional 4 mm catheter and 112 (26 %) using an open irrigated tip catheter. Segmental PVI targeting the earliest LA-PV activation for all PVs in each patient was used for all patients regardless of catheter for the entire study cohort. Radiofrequency energy was delivered for ≥60 secs at each target site. The pts in the 2 groups were similar with respect to age, gender and duration of AF. All 432 pts had successful complete PVI. There was no significant difference in the total number of lesions delivered per PV in the conventional 4 mm group and the irrigated tip group (Table ) at the initial procedure. Following a single procedure, 227/ 320 (71%) patients in the conventional 4 mm and 75/112 (67%) in the irrigated group were AF-free on no antiarrhythmic drug at 12 mos (p=0.43). The number of patients who required repeat procedures was similar in the conventional group (57/320, 18%) and the irrigated tip group (22/112, 20%) (p=0.66). Serious complications were also similar (2.2% vs. 1.0 %, p=0.21) Contrary to conventional wisdom, the safety and 12 month efficacy of PVI for management of AF was similar for the two types of ablation catheters. These data suggest that PVI cohorts derived from differing ablation techniques can be combined for purposes of clinical investigation. Longer term outcomes may differ and should be studied as well.

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