نبذة مختصرة : Purpose: Whether cryoballoon pulmonary veins isolation (CPVI) for paroxysmal AF influences on autonomic nervous system and therefore on the efficacy of the procedure. Patients: 57 patients (36 men, 57±11 years) without structural heart disease, diabetes mellitus, thyroid disorder, chronic kidney disease, sinus bradycardia and av conduction disturbances. Methods: Cryoablation with a 28 mm balloon catheter (Arctic Front, Medtronic Inc.) was applied for 5 minutes twice in each vein. A bradycardic response (heart rate <40 bpm, asystole, AV block, hypotension) was considered as evidence of vagal nerve activation. Heart rate variability (HRV) was used as an indicator of autonomic nervous system activity. 24-hour Holter monitoring was analyzed before and at 3 months after the procedure. All patients were followed for 6 months. Results: At follow-up time 76% of patients were free from arrhythmia. Transient vagal reflexes (VR) were noted in 36 % of patients and were documented during ablation of the left common trunk (12,5%) left superior PV (79%), left inferior PV (37,5%), both left PVs (29%). The presence of VR was not related to age, gender, LA diameter, PV diameter and minimal achieved temperature during application. 3 months after ablation a reduction in HRV was seen suggesting sympathetic overbalance but marked HRV changes were consistent with the presence of VR. At 6 months of follow-up AF recurrence was seen in 19% of patients with VR compared with 27% of patients without VR (p>0,05). Conclusions: Significant VR during CPVI indicate partial parasympathetic denervation that not increases the antiarrhythmic effect of the procedure.
Processing Request
No Comments.