title: Vagal Reactions during Cryoballoon-Based Pulmonary Vein Isolation: A Clue for Autonomic Nervous System Modulation?
abstract: Although paroxysmal atrial fibrillation (AF) is known to be initiated by rapid firing of pulmonary veins (PV) and non-PV triggers, the crucial role of cardiac autonomic nervous system (ANS) in the initiation and maintenance of AF has long been appreciated in both experimental and clinical studies. The cardiac intrinsic ANS is composed of ganglionated plexi (GPs), located close to the left atrium-pulmonary vein junctions and a vast network of interconnecting neurons. Ablation strategies aiming for complete PV isolation (PVI) remain the cornerstone of AF ablation procedures. However, several observational studies and few randomized studies have suggested that GP ablation, as an adjunctive strategy, might achieve better clinical outcomes in patients undergoing radiofrequency-based PVI for both paroxysmal and nonparoxysmal AF. In these patients, vagal reactions (VR) such as vagally mediated bradycardia or asystole are thought to reflect intrinsic cardiac ANS modulation and/or denervation. Vagal reactions occurring during cryoballoon- (CB-) based PVI have been previously reported; however, little is known on resulting ANS modulation and/or prevalence and significance of vagal reactions during PVI with the CB technique. We conducted a review of prevalence, putative mechanisms, and significance of VR during CB-based PVI.
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord, Aix-Marseille Université, 13915 Marseille Cedex 20, France.
authors.forename: Michaël
authors.initials: M
authors.lastname: Peyrol
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord, Aix-Marseille Université, 13915 Marseille Cedex 20, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Barraud
authors.affiliation: APHM, Department of Cardiology, Timone University Hospital, 13385 Marseille Cedex 05, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Koutbi
authors.affiliation: APHM, Department of Cardiology, Timone University Hospital, 13385 Marseille Cedex 05, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Maille
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord, Aix-Marseille Université, 13915 Marseille Cedex 20, France.
authors.forename: Lory
authors.initials: L
authors.lastname: Trevisan
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord, Aix-Marseille Université, 13915 Marseille Cedex 20, France.
authors.forename: Elisa
authors.initials: E
authors.lastname: Martinez
authors.affiliation: Aix-Marseille Université, 13284 Marseille Cedex 07, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lévy
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord, Aix-Marseille Université, 13915 Marseille Cedex 20, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
authors.affiliation: APHM, Department of Cardiology, Timone University Hospital, 13385 Marseille Cedex 05, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Franceschi
mesh_terms: D000818:Animals; D001341:Autonomic Nervous System / Q000502:physiology*; D003452:Cryosurgery / Q000379:methods; D005725:Ganglia, Autonomic / Q000502:physiology; D015171:Ganglionectomy / Q000379:methods; D006801:Humans; D064887:Observational Studies as Topic; D011667:Pulmonary Veins / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D014630:Vagus Nerve / Q000502:physiology*