Effect of Cryoballoon Ablation vs. Radiofrequency Ablation on Left Atrial Ganglionated Plexi in Patients with Atrial Fibrillation

Takahashi, K.; Watanabe, Ichiro; Okumura, Yasuo; Nagashima, Koichi; Watanabe, Ryuta; Arai, M.; Iso, Kazuki; Kurokawa, Syuhei; Okubo, Kimie; Nakai, Toshiko; Hirayama, Atsushi; Sonoda, Kazumasa; Tosaka, Toshimasa

doi:10.4264/numa.77.2_87

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…The most important of these relates to conventional pulmonary vein isolation and how it is appreciated that collateral injury to some of the GPs may in part contribute to more successful outcomes [72,73]. This is substantiated through studies using high-frequency stimulation (HFS) of GPs, showing abolition of vagal response after PVI; this has been demonstrated for both radiofrequency (RF) and cryoballoon ablation [74,75]. Specifically, the left superior GP is often ablated during isolation of the left superior vein, while the ligament of Marshall GP can be partly ablated during isolation of the left inferior or the left superior pulmonary veins.…”

Section: Discussionmentioning

confidence: 99%

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

O’Brien¹,

Reilly²,

Coffey³

et al. 2023

JCDD

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Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies.

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Section: Discussionmentioning

confidence: 99%

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

O’Brien¹,

Reilly²,

Coffey³

et al. 2023

JCDD

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“…Direct comparative data on RF-A vs. CB-A of GPs on AF outcome is scarce; however, some evidence suggests that no significant difference exists between the two ablation strategies ( 60 , 62 ).…”

Section: Autonomic Denervation During Cryoballoon Catheter Ablation F...mentioning

confidence: 99%

Cryoballoon ablation for atrial fibrillation: Effects on neuromodulation

Monte

Pannone

Bisignani

et al. 2022

Front. Cardiovasc. Med.

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Pulmonary vein isolation (PVI) represents the mainstay of atrial fibrillation (AF) ablation, and PVI with cryoballoon catheter (CB) ablation (CB-A) has proven to be as effective and safe as radiofrequency ablation (RF-A). Although AF is initiated by triggers arising from the pulmonary veins (PV) and non-PV foci, the intrinsic cardiac nervous system (ICNS) plays a significant role in the induction and maintenance of AF. The ICNS is an epicardial neural system composed of ganglionated plexi (GPs) and a complex network of interconnecting neurons. In the left atrium, the major GPs are located in proximity to the PV-left atrial junction. Vagal reactions have been described as markers of autonomic modulation during PVI with both RF-A and CB-A. The occurrence of neuromodulation during PVI with CB-A may be explained by both the anatomical relationship between the GPs and the PVs and the characteristics of the CB. Due to the CB/PV size mismatch, the CB creates a wide ablation area that extends from the PV ostium toward the antrum, possibly including the GPs. Although targeted GPs ablation, as a supplemental strategy to PVI, has been associated with a better AF outcome in patients undergoing RF-A, the additional clinical benefit of neuromodulation during PVI with CB-A remains a matter of debate. In this review, we provide an overview of the anatomy of the ICNS, the relationship between the ICNS and AF pathophysiology, and the current evidence on the clinical relevance of neuromodulation during PVI with CB-A.

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Effects of Pulmonary Vein Isolation on the Cardiac Autonomic Nervous System

隆太¹,

一郎²,

恭男³

et al. 2019

Nichidai Igaku Zasshi

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Background: Modulation of the intrinsic cardiac autonomic nervous system (ICANS) can occur after radiofrequency (RF) pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the effects of cryoballoon (CB) ablation and hot-balloon (HB) based PVI on the ICANS have not been evaluated. We compared the acute periprocedural effects on the ICAVS, as well as changes in heart rate variability (HRV) between RF-, CB-and HB-based PVI. Methods: The vagal response to high-frequency stimulation (25 Hz, 20 mA, 10 ms) applied to 5 major left atrial (LA)-ganglionated plexi (GP) before and after assessment of PVI in 31 patients with CB-PVI, 16 patients with HB (SATAKE Hot-BalloonTM, Toray, Tokyo, Japan), and 18 patients with RF-PVI. Among 47 patients (21: CB-PVI, 16: HB-PVI, and 10: RF-PVI) with sinus rhythm on admission, HRV was assessed for 5 minutes 1 day before and 2 days after PVI using high-resolution ECG (HRES-1000, FUKUDA DENSHI, Tokyo, Japan). Results: In the RF, CB and HB groups, 72%, 73% and 78% of the LA GPs were ablated. (P = 0.5018: N.S.) The change in heart rate (ΔHR) after PVI was increased significantly in the CB (+13.2 ± 7.1/min; P < 0.001), and HB groups (15.0 ± 8.0/min; P < 0.0001), but the HR did not change significantly in the RF group (+6.5 ± 11.3/min; P = N.S.). Conclusion: RF-, CB and HB-based PVIs affected the LA GPs response to a similar extent, but subsequent changes in heart rate exhibited different patterns between catheter-and balloon-based ablation.

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Effect of Cryoballoon Ablation vs. Radiofrequency Ablation on Left Atrial Ganglionated Plexi in Patients with Atrial Fibrillation

Cited by 3 publications

References 24 publications

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

Cryoballoon ablation for atrial fibrillation: Effects on neuromodulation

Effects of Pulmonary Vein Isolation on the Cardiac Autonomic Nervous System

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