Journal of Cardiovascular Electrophysiology

Volume 28, Issue 9 pp. 1015-1020

ORIGINAL ARTICLE

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

Shinsuke Miyazaki MD,

Corresponding Author

Shinsuke Miyazaki MD

[email protected]

orcid.org/0000-0002-0230-0934

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Correspondence

Shinsuke Miyazaki, MD, Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11–7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan.

Email: [email protected]

Search for more papers by this author

Hiroaki Nakamura MD,

Hiroaki Nakamura MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Hiroshi Taniguchi MD,

Hiroshi Taniguchi MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Hitoshi Hachiya MD,

Hitoshi Hachiya MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Takatsugu Kajiyama MD,

Takatsugu Kajiyama MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Tomonori Watanabe MD,

Tomonori Watanabe MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Miyako Igarashi MD,

Miyako Igarashi MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Sadamitsu Ichijo MD,

Sadamitsu Ichijo MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Kenzo Hirao MD,

Kenzo Hirao MD

Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan

Search for more papers by this author

Yoshito Iesaka MD,

Yoshito Iesaka MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Shinsuke Miyazaki MD,

Corresponding Author

Shinsuke Miyazaki MD

[email protected]

orcid.org/0000-0002-0230-0934

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Correspondence

Shinsuke Miyazaki, MD, Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11–7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan.

Email: [email protected]

Search for more papers by this author

Hiroaki Nakamura MD,

Hiroaki Nakamura MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Hiroshi Taniguchi MD,

Hiroshi Taniguchi MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Hitoshi Hachiya MD,

Hitoshi Hachiya MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Takatsugu Kajiyama MD,

Takatsugu Kajiyama MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Tomonori Watanabe MD,

Tomonori Watanabe MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Miyako Igarashi MD,

Miyako Igarashi MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Sadamitsu Ichijo MD,

Sadamitsu Ichijo MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

Kenzo Hirao MD,

Kenzo Hirao MD

Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan

Search for more papers by this author

Yoshito Iesaka MD,

Yoshito Iesaka MD

Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Search for more papers by this author

First published: 01 June 2017

https://doi.org/10.1111/jce.13262

Citations: 21

Disclosures: None

Share a link

Email
Wechat
Bluesky

Abstract

Background

The intrinsic cardiac autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF) mechanisms. This study evaluated the incidence and impact of intraprocedural vagal reactions and ANS modulation by pulmonary vein isolation (PVI) using second-generation cryoballoons on outcomes.

Methods

One hundred three paroxysmal AF patients underwent PVI with one 28-mm second-generation balloon. The median follow-up was 15.0 (12.0–18.0) months. ANS modulation was defined as a >20% cycle length decrease on 3-minute resting electrocardiograms at 1, 3, 6, and 12 months postindex procedure relative to baseline if sinus rhythm was maintained.

Results

Marked sinus arrests/bradycardia and atrioventricular block (intraprocedural vagal reaction) occurred in 14 and 2 patients, and all sinus arrest/bradycardia occurred in 44 patients with left superior pulmonary veins (PVs) targeted before right PVs. ANS modulation was identified in 66 of 95 (69.5%) patients, and it persisted 12-month postprocedure in 36 (37.9%) patients. Additional β-blocker administration was required in 9 patients for sinus tachycardia. ANS modulation was similarly observed in patients with and without intraprocedural vagal reactions (P = 0.443). Forty-eight (46.6%) patients experienced early recurrences, and the single procedure success at 12 months was 72.7%. Neither intraprocedural vagal reactions nor ANS modulation predicted AF freedom within or after the blanking period. Thirty-three patients underwent second procedures, and reconnections were detected in 39 of 130 (30.0%) PVs among 23 (69.7%) patients. The incidence of reconnections was similar in patients with and without ANS modulation.

Conclusions

Increased heart rate persisted in 37.9% of patients even at 12-month post-second-generation cryoballoon PVI. Neither intraprocedural vagal reactions nor increased heart rate predicted a single procedure clinical outcome.

REFERENCES

1Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. N Engl J Med. 1998; 339: 659–666.
10.1056/NEJM199809033391003
CAS PubMed Web of Science® Google Scholar
2Calkins H, Kuck KH, Cappato R, et al. Heart Rhythm Society Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm. 2012; 9: 632–696.
10.1016/j.hrthm.2011.12.016
PubMed Web of Science® Google Scholar
3Nakagawa H, Scherlag BJ, Patterson E, Ikeda A, Lockwood D, Jackman WM. Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation. Heart Rhythm. 2009; 6: S26–S34.
10.1016/j.hrthm.2009.07.029
PubMed Web of Science® Google Scholar
4Katritsis DG, Pokushalov E, Romanov A, et al. Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: A randomized clinical trial. J Am Coll Cardiol. 2013; 62: 2318–2325.
10.1016/j.jacc.2013.06.053
PubMed Web of Science® Google Scholar
5Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation. 2004; 109: 327—334.
10.1111/j.1540-8167.2005.50048.x
CAS PubMed Web of Science® Google Scholar
6Ketels S, Houben R, Van Beeumen K, Tavernier R, Duytschaever M. Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation. Europace. 2008; 10: 1406–1414.
10.1093/europace/eun287
PubMed Web of Science® Google Scholar
7Coulombe N, Paulin J, Su W. Improved in vivo performance of second-generation cryoballoon for pulmonary vein isolation. J Cardiovasc Electrophysiol. 2013; 24: 919–925.
10.1111/jce.12157
CAS PubMed Web of Science® Google Scholar
8Yorgun H, Aytemir K, Canpolat U, Şahiner L, Kaya EB, Oto A. Additional benefit of cryoballoon-based atrial fibrillation ablation beyond pulmonary vein isolation: Modification of ganglionated plexi. Europace. 2014; 16: 645–651.
10.1093/europace/eut240
PubMed Web of Science® Google Scholar
9Miyazaki S, Nakamura H, Taniguchi H, et al. Impact of the order of the targeted pulmonary vein on the vagal response during second-generation cryoballoon ablation. Heart Rhythm. 2016; 13: 1010–1017.
10.1016/j.hrthm.2015.12.031
PubMed Web of Science® Google Scholar
10Sacher F, Monahan KH, Thomas SP, et al. Phrenic nerve injury after atrial fibrillation catheter ablation: Characterization and outcome in a multicenter study. J Am Coll Cardiol. 2006; 47: 2498–2503.
10.1111/j.1540-8167.2009.01501.x
PubMed Web of Science® Google Scholar
11Lellouche N, Buch E, Celigoj A, et al. Functional characterization of atrial electrograms in sinus rhythm delineates sites of parasympathetic innervation in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol. 2007; 50: 1324–1331.
10.1016/j.jacc.2007.03.069
PubMed Web of Science® Google Scholar
12Peyrol M, Barraud J, Koutbi L, et al. Vagal reactions during cryoballoon-based pulmonary vein isolation: A clue for autonomic nervous system modulation? Biomed Res Int. 2016; 2016: 7286074. https://doi.org/10.1155/2016/7286074
10.1155/2016/7286074
PubMed Web of Science® Google Scholar
13Hou Y, Scherlag BJ, Lin J, et al. Ganglionated plexi modulate extrinsic cardiac autonomic nerve input: Effects on sinus rate, atrioventricular conduction, refractoriness, and inducibility of atrial fibrillation. J Am Coll Cardiol. 2007; 50: 61–68.
10.1016/j.jacc.2007.02.066
PubMed Web of Science® Google Scholar
14Verma N, Gillespie CT, Argento AC, et al. Bronchial effects of cryoballoon ablation for atrial fibrillation. Heart Rhythm. 2017; 14: 12–16.
10.1016/j.hrthm.2016.10.012
PubMed Web of Science® Google Scholar
15Miyazaki S, Kuroi A, Hachiya H, et al. Early recurrence after pulmonary vein isolation of paroxysmal atrial fibrillation with different ablation technologies—Prospective comparison of radiofrequency vs. second-generation cryoballoon ablation. Circ J. 2016; 80: 346–353.
10.1253/circj.CJ-15-1051
PubMed Web of Science® Google Scholar
16Hirose M, Leatmanoratn Z, Laurita KR, Carlson MD. Partial vagal denervation increases vulnerability to vagally induced atrial fibrillation. J Cardiovasc Electrophysiol. 2002; 13: 1272–1279.
10.1046/j.1540-8167.2002.01272.x
CAS PubMed Web of Science® Google Scholar
17Reddy VY, Sediva L, Petru J, et al. Durability of pulmonary vein isolation with cryoballoon ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) Study. J Cardiovasc Electrophysiol. 2015; 26: 493–500.
10.1111/jce.12626
PubMed Web of Science® Google Scholar
18Cappato R, Negroni S, Pecora D, et al. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation. 2003; 108: 1599–1604.
10.1161/01.CIR.0000091081.19465.F1
PubMed Web of Science® Google Scholar
19Martins RP, Hamon D, Césari O, et al. Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation. Heart Rhythm. 2014; 11: 386–393.
10.1016/j.hrthm.2014.01.002
PubMed Web of Science® Google Scholar
20Oswald H, Klein G, Koenig T, Luesebrink U, Duncker D, Gardiwal A. Cryoballoon pulmonary vein isolation temporarily modulates the intrinsic cardiac autonomic nervous system. J Interv Card Electrophysiol. 2010; 29: 57–62.
10.1007/s10840-010-9491-7
PubMed Web of Science® Google Scholar
21Yoshida K, Kaneshiro T, Ito Y, et al. Elevated plasma norepinephrine level and sick sinus syndrome in patients with lone atrial fibrillation. Heart. 2015; 101: 1133–1138.
10.1136/heartjnl-2014-307334
CAS PubMed Web of Science® Google Scholar
22Ng J, Villuendas R, Cokic I, et al. Autonomic remodeling in the left atrium and pulmonary veins in heart failure: Creation of a dynamic substrate for atrial fibrillation. Circ Arrhythm Electrophysiol. 2011; 4: 388–396.
10.1161/CIRCEP.110.959650
PubMed Web of Science® Google Scholar

Citing Literature

Volume28, Issue9

September 2017

Pages 1015-1020

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

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

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

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information