title: Additional benefit of cryoballoon-based atrial fibrillation ablation beyond pulmonary vein isolation: modification of ganglionated plexi.
abstract: OBJECTIVE
  It has been known that cryoballoon-based pulmonary vein isolation (PVI) is an efficacious and a safe therapeutic option to eliminate triggers of atrial fibrillation (AF). However, the effect of cryoablation on external modifiers of AF-like ganglionated plexi (GP) has never been investigated. In this study, we aimed to investigate whether vagal reactions probably due to GP modification during cryoablation, are associated with success rates during follow-up.
  
  
  RESULTS
  A total of 145 patients (age: 54.5 ± 10.1, 52.4% males and 80.7% paroxysmal AF) who were symptomatic despite treatment with ≥ 1 antiarrhythmic drug underwent PVI with cryoballoon. Occurrences of intraprocedural vagal reactions were recorded in all patients. Intraprocedural vagal reaction was observed in 59 patients (40.7%). Vagal reaction characterized by bradycardia and hypotension was more common in patients free of AF recurrence as was the requirement of atropine administration or temporary pacing (46.2 vs. 15.4%, P = 0.004 and 38.7 vs. 7.7%, P = 0.002, respectively). At a median 17 (4-27) months follow-up, AF recurrence was observed in 26 (17.9%) patients. Multivariate Cox regression analysis showed that non-paroxysmal AF, left atrial diameter, and early recurrence significantly increased AF recurrence; however, requirement of atropine administration or temporary pacing (hazard ratio: 0.064; 95% confidence interval: 0.008-0.48, P = 0.008) decreased AF recurrence.
  
  
  CONCLUSIONS
  Our findings indicate that vagal reactions during cryoablation, as a surrogate marker of cardiac ANS modification, decrease AF recurrence in a subgroup of patients with paroxysmal and persistent AF. This finding may be attributed to the concomitant ablation of GP during antral PVI.
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Hikmet
authors: H
authors: Yorgun
authors: Kudret
authors: K
authors: Aytemir
authors: Uğur
authors: U
authors: Canpolat
authors: Levent
authors: L
authors: Şahiner
authors: Ergun Barış
authors: EB
authors: Kaya
authors: Ali
authors: A
authors: Oto
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001919:Bradycardia / Q000453:epidemiology*; D015331:Cohort Studies; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005725:Ganglia, Autonomic / Q000503:physiopathology / Q000601:surgery*; D015171:Ganglionectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*
keywords: Atrial fibrillation; Cryoablation; Recurrence; Vagal reaction