Distance‐dependent neuromodulation effect during thermal ablation for atrial fibrillation

• Published in: Journal of cardiovascular electrophysiology Vol. 35; no. 10; pp. 1997 - 2005
• Main Authors: Nakasone, Kazutaka, Tanaka, Kaoru, Del Monte, Alvise, Della Rocca, Domenico Giovanni, Pannone, Luigi, Mouram, Sahar, Cespón‐Fernández, María, Doundoulakis, Ioannis, Marcon, Lorenzo, Audiat, Charles, Vetta, Giampaolo, Scacciavillani, Roberto, Overeinder, Ingrid, Bala, Gezim, Sorgente, Antonio, Sieira, Juan, Almorad, Alexandre, Fukuzawa, Koji, Hirata, Ken‐ichi, Brugada, Pedro, Sarkozy, Andrea, Chierchia, Gian Battista, Asmundis, Carlo, Ströker, Erwin
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-10-2024
• Subjects: Ablation; atrial fibrillation; Autonomic nervous system; Balloon treatment; Cans; Cardiac arrhythmia; cardiac autonomic nervous system; Computed tomography; Fibrillation; ganglionated plexus; Heart rate; Innervation; Neuromodulation; Parasympathetic nervous system; Patients; neuromodulation; cardiac autonomic nervous system; atrial fibrillation; ablation; ganglionated plexus
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16401

Introduction
Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation‐induced CANS changes, as assessed via variations in heart rate (HR) postablation.
Methods
Consecutive paroxysmal AF patients undergoing first‐time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12‐month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24‐h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV‐SVC distance).
Results
A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV‐SVC distance (odds ratio [OR]: 0.49, CI: 0.34–0.71, p value < .001), and age (OR: 0.94, CI: 0.89–0.98, p value = .003).
Conclusions
Thermal balloon‐based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV‐SVC distance.
Predictors of cardiac neuromodulation during thermal balloon‐based ablation for atrial fibrillation. Left panel shows an illustration of the two thermal balloon‐based ablation catheters used and the location of the right anterior ganglionated plexus (RAGP) in relation to the left atrium. Right panel presents the independent predictors found for significant heart rate (HR) increase and illustrative examples of the anatomic variable on axial computed tomography images placed at the level of the right superior pulmonary vein (RSPV) with visualization of the balloon catheter and RAGP. The distance between RSPV and superior vena cava (SVC) is illustrated with the red boxes. CB, cryoballoon; HR, heart rate; RF, radiofrequency; RSPV, right superior pulmonary vein; SVC, superior vena cava.