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

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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B-PO02-074 LEFT ATRIAL APPENDAGE CLOSURE IMPACT ON ATRIAL FIBRILLATION RECURRENCE-RATE IN PATIENTS UNDERGOING PULMONARY VEIN ISOLATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.472 ◽

2021 ◽

Vol 18 (8) ◽

pp. S126

Author(s):

Ciro Ascione ◽

Marco Bergonti ◽

Valentina Catto, Stefania I. Riva ◽

Massimo Moltrasio ◽

Fabrizio Tundo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Recurrence Rate ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Atrial Fibrillation Recurrence ◽

Left Atrial Appendage Closure

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

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.586 ◽

2021 ◽

Vol 18 (8) ◽

pp. S234

Author(s):

Predrag Stojadinovic ◽

Dan Wichterle ◽

Petr Peichl ◽

Robert Cihak ◽

Helena Jansova ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Pulse Field ◽

Radiofrequency Energy ◽

Cardiac Innervation ◽

Acute Change

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Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation

EP Europace ◽

10.1093/europace/euaa383 ◽

2020 ◽

Author(s):

Michelle Lycke ◽

Maria Kyriakopoulou ◽

Milad El Haddad ◽

Jean-Yves Wielandts ◽

Gabriela Hilfiker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Prospective Trial ◽

High Rate ◽

Binary Logistic Regression Analysis ◽

Ablation Time ◽

Increased Risk ◽

Af Recurrence

Abstract Aims Catheter ablation of paroxysmal atrial fibrillation (AF) reduces AF recurrence, AF burden, and improves quality of life. Data on clinical and procedural predictors of arrhythmia recurrence are scarce and are flawed by the high rate of pulmonary vein reconnection evidenced during repeat procedures after pulmonary vein isolation (PVI). In this study, we identified clinical and procedural predictors for AF recurrence 1 year after CLOSE-guided PVI, as this strategy has been associated with an increased PVI durability. Methods and results Patients with paroxysmal AF, who received CLOSE-guided PVI and who participated in a prospective trial in our centre, were included in this study. Uni- and multivariate models were plotted to find clinical and procedural predictors for AF recurrence within 1 year. Three hundred twenty-five patients with a mean age of 63 years (CHA2DS2VASc 1 [1–3], left atrium diameter 41 ± 6 mm) were included. About 60.9% were male individuals. After 1 year, AF recurrence occurred in 10.5% of patients. In a binary logistic regression analysis, the diagnosis-to-ablation time (DAT) was found to be the strongest predictor of AF recurrence (P = 0.011). Diagnosis-to-ablation time ≥1 year was associated with a nearly two-fold increased risk for developing AF recurrence. Conclusion The DAT is the most important predictor of arrhythmia recurrence in low-risk patients treated with durable pulmonary vein isolation for paroxysmal AF. Whether reducing the DAT could improve long-term outcomes should be investigated in another trial.

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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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What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring

Heart Rhythm ◽

10.1016/j.hrthm.2018.07.016 ◽

2018 ◽

Vol 15 (12) ◽

pp. 1844-1850 ◽

Cited By ~ 12

Author(s):

Christian-Hendrik Heeger ◽

Verena Tscholl ◽

Omar Salloum ◽

Erik Wissner ◽

Thomas Fink ◽

...

Keyword(s):

Pulmonary Vein ◽

Recurrence Rate ◽

Pulmonary Vein Isolation ◽

The Real ◽

Cardiac Devices

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Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

Bulgarian Cardiology ◽

10.3897/bgcardio.27.e71311 ◽

2021 ◽

Vol 27 (3) ◽

pp. 55-68

Author(s):

Svetla Dineva ◽

Milko Stoyanov ◽

Aneliya Partenova ◽

Boyan Kunev ◽

Victoria Stoyanova ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Local Population ◽

Venous Drainage ◽

Anatomical Variant ◽

Cox Regression Analysis ◽

Anatomical Variants ◽

The Impact ◽

Variant Anatomy ◽

Af Recurrence

Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial ﬁ brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signiﬁ cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after ﬁ rst pulmonary vein isolation.

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Abstract 15934: Comparison of Atrial Fibrillation Burden Reduction in Patients With Paroxysmal and Persistent Atrial Fibrillation Undergoing Cryoballoon Pulmonary Vein Isolation

Circulation ◽

10.1161/circ.142.suppl_3.15934 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Dan L Musat ◽

Nicolle S Milstein ◽

Jacqueline Pimienta ◽

Advay Bhatt ◽

Tina C Sichrovsky ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Persistent Atrial Fibrillation ◽

Loop Recorder ◽

Similar Reduction ◽

Af Ablation ◽

Ablation Success ◽

One Year ◽

Af Recurrence

Background: Pulmonary vein isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation procedures to treat symptomatic AF. Ablation success is defined by absence of AF recurrence >30 seconds. However, reduction in AF burden (AFB) is also an important endpoint. Whether patients with paroxysmal (PAF) and persistent AF (PeAF) have similar reduction in AFB post-ablation is unknown. Objective: To compare the decrease in AFB following cryoballoon (CB) PVI in patients with PAF and PeAF. Methods: We enrolled consecutive pts with an implantable loop recorder (ILR) who subsequently underwent CB PVI. All patients were followed prospectively for at least one year, or until repeat ablation; we compared AFB pre and post-ablation. Results: The cohort included had 47 patients (66 ± 10 years; 32 [68%] male; PAF [n=23, 49%]; CHA 2 DS 2 -VASc 2.7 ± 1.7, 34 [72%] on AAD at the time of ablation). A median of 136 days [IQR 280, 73; minimum of 30 days] of ILR data pre-ablation were available. The median AFB for PAF was 4.7% [IQR 0.9, 14.8] and PeAF was 6.8% [IQR 1.1, 40.4]. After excluding a 3-month post-ablation blanking period, recurrent AF occurred in 12 (52%) PAF and 11 (46%) PeAF patients. The median AFB post-ablation for PAF and PeAF cohorts was 0.03%, [IQR 0, 0.3] and 0.04%, [IQR 0, 1.1], respectively. This represents a >99% reduction in AFB. Conclusion: Although 50% of patients undergoing CB PVI for PAF or PeAF had a recurrence of AF, there was >99% reduction in AFB in both groups. These data highlight the importance of using AFB burden as a marker of therapeutic efficacy post-AF ablation.

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Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation

International Heart Journal ◽

10.1536/ihj.49.661 ◽

2008 ◽

Vol 49 (6) ◽

pp. 661-670 ◽

Cited By ~ 10

Author(s):

Kimie Ohkubo ◽

Ichiro Watanabe ◽

Yasuo Okumura ◽

Sonoko Ashino ◽

Masayoshi Kofune ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Combined Effect ◽

Autonomic Nerves

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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

Cardiology Research and Practice ◽

10.1155/2016/8632509 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13 ◽

Cited By ~ 12

Author(s):

Paolo D. Dallaglio ◽

Timothy R. Betts ◽

Matthew Ginks ◽

Yaver Bashir ◽

Ignasi Anguera ◽

...

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Waiting Time ◽

Critical Review ◽

Recurrence Rates ◽

The Impact ◽

Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

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Intraprocedural endpoints to predict durable pulmonary vein isolation: a randomized trial of four post-ablation techniques

EP Europace ◽

10.1093/europace/euz301 ◽

2019 ◽

Vol 22 (4) ◽

pp. 567-575 ◽

Cited By ~ 4

Author(s):

Ruhong Jiang ◽

Minglong Chen ◽

Bing Yang ◽

Qiang Liu ◽

Zuwen Zhang ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Af Ablation ◽

Group 4 ◽

Initial Procedure ◽

Group 2 ◽

Waiting Periods ◽

The Impact ◽

Af Recurrence

Abstract Aims The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. Methods and results In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). Conclusion Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI.

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