Background

Vagal responses (VRs) are often seen in patients undergoing circumferential pulmonary vein isolation (CPVI). The possible mechanism of VR is that CPVI creates a coincidental modification of the cardiac ganglionated plexi (GP).

Aim

To investigate whether the presence of VR during CPVI impacts post-ablation recurrence in patients with paroxysmal atrial fibrillation (AF).

Methods

A total of 112 consecutive patients with symptomatic paroxysmal AF who underwent CPVI for the first time from October 1, 2017 to April 30, 2019 were prospectively enrolled, of which two were lost the follow-up. Patients were divided into two groups based on whether VRs were experienced during CPVI. Electrophysiological parameters, including atrial effective refractory period (AERP) and mean heart rate (MHR), were measured before and post-ablation. The patients were then followed up for 12 months.

Results

The 71 patients who had experienced VRs during CPVI were assigned to group B, and the remaing 39 patients who did not experience VR during CPVI were assigned to group A. The MHR (79.6 ± 8.3 vs 70.4 ± 7.8 b/min; p ≤ 0.001) was significantly higher; and the AERP (244 ± 22 vs 215 ± 27 ms; p ≤ 0.001) was prolonged in group B compared to respective pre-ablation values. There were no significant changes in the MHR (69.5 ± 7.9 vs 69.7 ± 8.7 b/min; p = 0.541) and AERP (224 ± 28 vs 225 ± 33 ms; p = 0.542) in group A. During the first four months of follow-up after ablation, the MHR gradually slowed down to pre-procedural levels in group B. The recurrence of AF (6/71 vs 7/39; p = 0.023) significantly decreased in group B relative to group A during the first 6 months after ablation, but there was no significant difference (14/71 vs 9/39; p = 0.598) at the end of the 12-month follow-up period.

Conclusion

Patients with paroxysmal AF who develop VRs during CPVI might have a decreased recurrence of AF and accelerated MHR in the short-term.

中文翻译：

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环肺静脉隔离期间的迷走神经反应减少阵发性房颤患者短期内房颤的复发：一项前瞻性、观察性研究

背景

迷走神经反应 (VR) 常见于接受环肺静脉隔离 (CPVI) 的患者。VR 的可能机制是 CPVI 对心脏神经节丛 (GP) 进行了巧合修饰。

目标

研究 CPVI 期间 VR 的存在是否会影响阵发性心房颤动 (AF) 患者的消融后复发。

方法

前瞻性纳入2017年10月1日至2019年4月30日首次接受CPVI的有症状阵发性房颤患者112例，其中2例失访。根据 CPVI 期间是否经历 VR 将患者分为两组。在消融前后测量电生理参数，包括心房有效不应期（AERP）和平均心率（MHR）。然后对患者进行了 12 个月的随访。

结果

谁CPVI期间没有经历VR 71例谁CPVI期间经历过的VR被分配到B组，并且remaing 39名患者被分配到A组的MHR（79.6±8.3 VS 70.4±7.8 B /分钟; p  ≤0.001 )明显更高；与各自的消融前值相比，B 组的 AERP（244 ± 22 对 215 ± 27 ms；p ≤ 0.001）延长。A 组的 MHR（69.5 ± 7.9 vs 69.7 ± 8.7 b/min；p  = 0.541）和 AERP（224 ± 28 vs 225 ± 33 ms；p  = 0.542）没有显着变化。在前四个月消融后随访，B 组 MHR 逐渐减慢至术前水平。 AF 复发（6/71 对 7/39；p = 0.023) 在消融后的前 6 个月内，B 组相对于 A 组显着降低，但 在 12 个月随访结束时没有显着差异（14/71 对 9/39；p = 0.598）时期。

结论

在 CPVI 期间发生 VR 的阵发性 AF 患者可能会在短期内减少 AF 的复发并加速 MHR。