High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

Paul-Adrian Călburean; Thiago Guimarães Osório; Juan Sieira; Erwin Ströker; Riccardo Maj; Muryo Terasawa; Alessandro Rizzo; Gianluca Borio; Oriana Scala; Alessio Galli; Pedro Brugada; Gian-Battista Chierchia; Carlo De Asmundis

doi:10.1007/s10840-019-00687-9

High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

J Interv Card Electrophysiol. 2021 Jan;60(1):21-29. doi: 10.1007/s10840-019-00687-9. Epub 2020 Jan 7.

Affiliations

¹ Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium.
² Doctoral School, University of Medicine, Pharmacy, Sciences and Technology "George Emil Palade", 38 Gheorghe Marinescu Street, Târgu Mureș, 530149, Romania.
³ Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium. carlo.deasmundis@uzbrussel.be.

PMID: 31912449
DOI: 10.1007/s10840-019-00687-9

Abstract

Purpose: High parasympathetic nervous system (PNS) activity is accurately reflected by deceleration capacity (DC) and is involved in atrial fibrillation (AF) recurrence after catheter ablation procedure. When compared with initial catheter ablation procedure, repeated procedures for AF recurrence are followed by a lower success rates, estimated at 50%. Our objective was to evaluate the impact of PNS activity assessed by DC measured before repeated procedure on AF recurrence after repeated procedure.

Methods: Consecutive patients who underwent an initial catheter ablation procedure for pulmonary vein (PV) isolation and a repeated catheter ablation procedure for AF recurrence were selected. Additional 24-h ambulatory electrocardiographic recording between procedures for DC measurement was required for inclusion. A total of 110 patients were included. Seventy-two patients underwent cryoballoon (CB) ablation and 38 patients underwent radiofrequency (RF) ablation as initial procedure, while all patients underwent RF ablation as repeated procedure.

Results: DC was higher in cases with right-sided PV reconnection (p = 0.04, OR = 1.38, 95% CI = 1.08-1.78). In patients with CB ablation as initial procedure, DC was higher in patients with PV reconnection (p = 0.03, OR = 1.29, 95% CI = 1.11-1.70), and the number of reconnected PVs was higher in patients with DC ≥ 7.0 ms (median DC value used for dichotomization, p = 0.02, OR = 2.19, 95% CI = 1.10-4.37). In multivariate Cox regression, DC predicted AF recurrence after repeated ablation (p = 0.004, HR = 1.68, 95% CI = 1.35-1.82). In multivariate binary regression, DC predicted persistent AF type recurrence after repeated ablation (p = 0.01, OR = 1.50, 95% CI = 1.10-2.02).

Conclusions: DC is a novel predictor of AF recurrence and AF recurrence type after repeated catheter ablation procedure. DC may reflect the need of more intensive treatment strategies in patients with high PNS activity.

Keywords: Atrial fibrillation; Atrial fibrillation recurrence; Catheter ablation; Deceleration capacity; Pulmonary vein isolation.

MeSH terms

Atrial Fibrillation* / diagnostic imaging
Atrial Fibrillation* / surgery
Catheter Ablation*
Deceleration
Humans
Parasympathetic Nervous System*
Pulmonary Veins* / diagnostic imaging
Pulmonary Veins* / surgery
Recurrence
Treatment Outcome