Impact of the order of the targeted pulmonary vein on the vagal response during second-generation cryoballoon ablation

Miyazaki, Shinsuke; Nakamura, Hiroaki; Taniguchi, Hiroshi; Ichihara, Noboru; Takagi, Takamitsu; Iwasawa, Jin; Kuroi, Akio; Watanabe, Tomonori; Hirao, Kazuyuki; Iesaka, Yoshito

doi:10.1016/j.hrthm.2015.12.031

Cited by 38 publications

(44 citation statements)

References 18 publications

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“…The present study initially showed a rise in BP during the freezing phase, recovery of BP during the initial thawing phase, and a sharp drop in BP after releasing PV occlusion. Prior studies showed that cryoablation at the LSPV could result in bradycardia due to a vagal response during the thawing phase, and this reaction disappeared with a preceding RSPV ablation . In the present study, the order of the targeted PVs and vagal denervation by the administration of atropine did not have an impact on BP change, suggesting that the association of ganglionated plexi and the autonomic nervous system was limited.…”

Section: Discussionsupporting

confidence: 43%

“…Indeed, the elevated BP recovered to the baseline level during the initial thawing phase (T 3 min to T 15°C ) before balloon deflation. The increase in heart rate during the initial freezing phase at the RSPV could be explained by the destruction of the efferent vagal neurons from the anterior right ganglionated plexus projecting onto the sinoatrial node by RSPV ablation …”

Section: Discussionmentioning

confidence: 99%

“…A spiral mapping catheter was used to advance the cryoballoon into the PV for support and mapping the PV potentials. When the left PVs (LPVs) were initially targeted (LPV‐first group), atropine sulfate was always administered before ablation to anticipate bradycardia caused by a vagal reaction . Following sealing at the PV antrum, complete occlusion was confirmed by injecting contrast medium.…”

Section: Methodsmentioning

confidence: 99%

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Circulatory Dynamics During Pulmonary Vein Isolation Using the Second‐Generation Cryoballoon

Kajiyama

Miyazaki

Watanabe

et al. 2017

JAHA

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BackgroundCirculatory dynamics change during pulmonary vein (PV) isolation using cryoballoons. This study sought to investigate the circulatory dynamics during cryoballoon‐based PV isolation procedures and the contributing factors.Methods and ResultsThis study retrospectively included 35 atrial fibrillation patients who underwent PV isolation with 28‐mm second‐generation cryoballoons and single 3‐minute freeze techniques. Blood pressures were continuously monitored via arterial lines. The left ventricular function was evaluated with intracardiac echocardiography throughout the procedure in 5 additional patients. Overall, 126 cryoapplications without interrupting freezing were analyzed. Systolic blood pressure (SBP) significantly increased during freezing (138.7±28.0 to 148.0±27.2 mm Hg, P<0.001) and sharply dropped (136.3±26.0 to 95.0±17.9 mm Hg, P<0.001) during a mean of 21.0±8.0 seconds after releasing the occlusion during thawing. In the multivariate analyses, the left PVs (P=0.008) and lower baseline SBP (P<0.001) correlated with a larger SBP rise, whereas a higher baseline SBP (P<0.001), left PVs (P=0.017), lower balloon nadir temperature (P=0.027), and female sex (P=0.045) correlated with larger SBP drops. These changes were similarly observed regardless of preprocedural atropine administration and the target PV order. PV occlusions without freezing exhibited no SBP change. PV antrum freezing without occlusions similarly increased the SBP, but the SBP drop was significantly smaller than that with occlusions (P<0.001). The SBP drop time‐course paralleled the left ventricular ejection fraction increase (66.8±8.1% to 79.3±6.7%, P<0.001) and systemic vascular resistance index decrease (2667±1024 to 1937±513 dynes‐sec/cm2 per m2, P=0.002).ConclusionsWith second‐generation cryoballoon‐based PV isolation, SBP significantly increased during freezing owing to atrial tissue freezing and dropped sharply after releasing the occlusion, presumably because of the peripheral vascular resistance decrease mainly by circulating chilled blood.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Circulatory Dynamics During Pulmonary Vein Isolation Using the Second‐Generation Cryoballoon

Kajiyama

Miyazaki

Watanabe

et al. 2017

JAHA

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“…A few studies demonstrated that intraprocedural vagal reactions during the PVI and vagal denervation by the PVI could be a predictor of a better clinical outcome; however, the results are controversial . One of the probable explanations is that a GP modulation might suppress the focal firing within the reconnected PVs post‐PVI .…”

Section: Discussionmentioning

confidence: 99%

Autonomic nervous system modulation and clinical outcome after pulmonary vein isolation using the second‐generation cryoballoon

Miyazaki

Nakamura

Taniguchi

et al. 2017

Cardiovasc electrophysiol

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“…However, in this case the patient did not have any atrioventricular block or asystole during the cryoablation procedure of the left PV. We previously reported 11 a reasonable approach during cryoablation targeting the right PVs prior to the LSPV to prevent any vagal response, including asystole, during the ablation of the LSPV. We also performed the cryoablation of the LSPV following the right PVs to prevent any bradycardia during the procedure in this case.…”

Section: Discussionmentioning

confidence: 99%

Impact of the order of the targeted pulmonary vein on the vagal response during second-generation cryoballoon ablation

Cited by 38 publications

References 18 publications

Circulatory Dynamics During Pulmonary Vein Isolation Using the Second‐Generation Cryoballoon

Circulatory Dynamics During Pulmonary Vein Isolation Using the Second‐Generation Cryoballoon

Autonomic nervous system modulation and clinical outcome after pulmonary vein isolation using the second‐generation cryoballoon

Recurrent and late-onset coronary spasms after cryoballoon ablation procedure in a patient with atrial fibrillation

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