BACKGROUND The impact of pulmonary vein isolation (PVI) performed with cryoballoon (CB) on the intrinsic cardiac autonomic nervous system (ICANS) remains unclear. OBJECTIVE The purpose of this study was to evaluate the predictors and the clinical meaning of cardiac neuromodulation achieved by CB-ablation as assessed by sinus heart rate (HR) response after the procedure. METHODS Patients who underwent CB-ablation for drug-resistant atrial fibrillation (AF) from January 2014 to October 2018 were included. Twelve‑leads rest ECG was taken both before and after the procedure. After discharge, patients were scheduled for follow-up visits at 1, 3, 6, and 12 months and 24 h Holter recordings were obtained at each follow-up visit. All documented AF episodes of >30 s were considered as recurrence. RESULTS Four-hundred seventy-two patients (62.3% male, age 56.7 ± 13.6 years, 97.2% paroxysmal AF) were included. Mean HR before the procedure was 60.17 ± 10.4 bpm, while the morning after the procedure mean HR was 75.48 ± 12.0 bpm. Age at enrollment (R = -0.26; p < 0.001), baseline HR before the CB-A (R = -0.32; p < 0.001), nadir temperature in each right pulmonary vein (R = -0.11, p = 0.022; R = -0.16; p = 0.001) were significantly associated with the ∆HR. At 2-year follow-up, freedom from recurrences was 83.1% for the patients with HR increase ≥15 bpm after CB-A and 66.3% in patients with HR increase ˂15 bpm (p = 0.021). CONCLUSION Sinus HR increase is a frequent phenomenon after CB-A, that can be predicted by both clinical and procedural factors and that correlates with better outcome after cryo-PVI.

中文翻译：

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消融前窦性心律的房颤患者通过冷冻气球消融实现的心脏神经调节的预测因子。

背景技术用冷冻气球（CB）进行的肺静脉隔离（PVI）对内在的心脏自主神经系统（ICANS）的影响尚不清楚。目的本研究的目的是评估通过CB消融术实现的心脏神经调节的预测因子和临床意义，并通过手术后的窦性心率（HR）反应进行评估。方法纳入2014年1月至2018年10月接受CB消融治疗耐药性心房纤颤（AF）的患者。术前和术后均采取十二导联心电图。出院后，将患者安排在第1、3、6和12个月进行随访，并在每次随访中获得24小时动态心电图记录。所有已记录的> 30 s的AF发作均被视为复发。结果242例患者（62.3％男性，年龄56.7±13.6岁，阵发性房颤97.2％。手术前的平均心率是60.17±10.4 bpm，而手术后的早晨，平均心率是75.48±12.0 bpm。入组年龄（R = -0.26; p <0.001），CB-A前的基线HR（R = -0.32; p <0.001），右肺静脉的最低温度（R = -0.11，p = 0.022; R = -0.16; p = 0.001）与ΔHR显着相关。在2年的随访中，CB-A后HR升高≥15 bpm的患者复发率为83.1％，HR升高≥15 bpm的患者为66.3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。手术前的平均心率是60.17±10.4 bpm，而手术后的早晨，平均心率是75.48±12.0 bpm。入组年龄（R = -0.26; p <0.001），CB-A前的基线HR（R = -0.32; p <0.001），右肺静脉的最低温度（R = -0.11，p = 0.022; R = -0.16; p = 0.001）与ΔHR显着相关。在2年的随访中，CB-A后HR升高≥15 bpm的患者复发率为83.1％，HR升高≥15 bpm的患者为66.3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。手术前的平均心率是60.17±10.4 bpm，而手术后的早晨，平均心率是75.48±12.0 bpm。入组年龄（R = -0.26; p <0.001），CB-A前的基线HR（R = -0.32; p <0.001），右肺静脉的最低温度（R = -0.11，p = 0.022; R = -0.16; p = 0.001）与ΔHR显着相关。在2年的随访中，CB-A后HR升高≥15 bpm的患者复发率为83.1％，HR升高≥15 bpm的患者为66.3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。CB-A之前的基线HR（R = -0.32; p <0.001），每条右肺静脉的最低温度（R = -0.11，p = 0.022; R = -0.16; p = 0.001）与∆显着相关人力资源部 在2年的随访中，CB-A后HR升高≥15 bpm的患者复发率为83.1％，HR升高≥15 bpm的患者为66.3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。CB-A之前的基线HR（R = -0.32; p <0.001），每条右肺静脉的最低点温度（R = -0.11，p = 0.022; R = -0.16; p = 0.001）与∆显着相关人力资源部 在2年的随访中，CB-A后HR升高≥15 bpm的患者复发率为83.1％，HR升高≥15 bpm的患者为66.3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。HR升高≥15 bpm的患者中有3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。HR升高≥15 bpm的患者中有3％（p = 0.021）。结论窦性心律增高是CB-A术后的常见现象，可由临床和手术因素共同预测，并与冷冻PVI后更好的预后相关。