Analysis of the heart rate variability during cryoballoon ablation of atrial fibrillation

Abstract

A marked increase in the HRV parameters was observed just after the CB ablation. An initial CB ablation of the right PVs decreased the change in the autonomic tone during the right PV ablation and subsequent left PV ablation. It prevented an excessive vagal response during the CB ablation and might be a safe procedure.

A novel strategy to treat vaso-vagal syncope: Cardiac neuromodulation by cryoballoon pulmonary vein isolation

“…In an elegant work from Mori et al. [ 34 ] conducted on 54 paroxysmal AF patients who underwent CB-A (25 patients starting from the right-side PVs and 29 patients targeting the left-side PVs first), a vagal response was observed in 61.5% of the left-first group of patients while only in the 9.5% of the patients from the right-first group, suggesting that the initial CB ablation of the RSPV may affect the anterior right GP and may suppress its function as an integration centre for the SN. More recently, Hu et al.…”

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

“…Interestingly, most of episodes of restoration of SR (69.8%) in our case group occurred while performing right PVs cryo‐applications. Despite the frequent localization of focal AF triggers in the RSPV and the central role of the cryo‐applications on the right‐side PVs in modifying the cardiac autonomic nervous system, the electrophysiological and clinical significance of this observation remains unclear; moreover, since right PVs cryo‐applications are the ones performed in the second half of the procedure, some role and/or a cumulative effect of previous cryo‐applications on the results described cannot be excluded. Since the area targeted by CB is wide and antral, the extent of the lesion created by the cryo‐application may also involve other structures of the LA which may have a role in maintaining AF.…”

“…dergoing CB-A with second-generation CB. Furthermore, in a recent work from Gramlich et al,34 the degree of atrial fibrosis was proved to correlate with the risk of AF recurrence at 1 year follow-up after CB-A in 60 patients with persistent AF, therefore stressing the relevance of possible residual substrate areas besides PVs in those patients with a large extent of low-voltage areas and more generally of the LA disease.Interestingly, most of episodes of restoration of SR (69.8%) in our case group occurred while performing right PVs cryo-applications.Despite the frequent localization of focal AF triggers in the RSPV35 and the central role of the cryo-applications on the right-side PVs in modifying the cardiac autonomic nervous system,36,37 the electrophysiological and clinical significance of this observation remains unclear; moreover, since right PVs cryo-applications are the ones performed in the second half of the procedure, some role and/or a cumulative effect of previous cryo-applications on the results described cannot be excluded. Since the area targeted by CB is wide and antral,38 the extent of the lesion created by the cryo-application may also involve other structures of the LA which may have a role in maintaining AF.…”

Impact of cryoballoon-guided pulmonary vein isolation on non-invasive autonomic tests in patients with paroxysmal atrial fibrillation

“…The role of the cardiac ANS in the development and maintenance of atrial fibrillation (AF) has been largely studied in animal and in vitro models [1,3]. Due to the proximity of the GP and the PVs, several studies have assessed the influence of pulmonary vein isolation (PVI) on the intrinsic cardiac ANS [[4], [5], [6], [7], [8]]. The consistent autonomic modulatory effect of PVI seems to be attenuation of parasympathetic activity (vagal denervation), as shown in previous studies, most of them using heart rate (HR) increase, heart rate variability (HRV) or vagal reactions (VR) during ablation as markers of intrinsic cardiac ANS modulation [[4], [5], [6]].…”

“…Due to the proximity of the GP and the PVs, several studies have assessed the influence of pulmonary vein isolation (PVI) on the intrinsic cardiac ANS [[4], [5], [6], [7], [8]]. The consistent autonomic modulatory effect of PVI seems to be attenuation of parasympathetic activity (vagal denervation), as shown in previous studies, most of them using heart rate (HR) increase, heart rate variability (HRV) or vagal reactions (VR) during ablation as markers of intrinsic cardiac ANS modulation [[4], [5], [6]]. Current guidelines for the management of syncope [9] recommend the use of non-invasive autonomic function tests as Valsalva maneuver (class IIa) and deep breathing (class IIa) and to a lesser extent the 30:15 ratio, cold pressure and sustained hand grip test (all three IIb) in the identification of autonomic failure as the underlying cause of syncope.…”