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Open Access 01-01-2021 | Antiarrhythmic Drugs | Original Paper

Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation

Authors: Lara Wagner, Fabrice F. Darche, Dierk Thomas, Patrick Lugenbiel, Panagiotis Xynogalos, Svenja Seide, Eberhard P. Scholz, Hugo A. Katus, Patrick A. Schweizer

Published in: Clinical Research in Cardiology | Issue 1/2021

Abstract

Background

Modulation of the cardiac autonomic nervous system by pulmonary vein isolation (PVI) influences the sinoatrial nodal rate. Little is known about the causes, maintenance and prognostic value of this phenomenon. We set out to explore the effects of cryoballoon PVI (cryo-PVI) on sinus rate and its significance for clinical outcome.

Methods and results

We evaluated 110 patients with paroxysmal atrial fibrillation (AF), who underwent PVI using a second-generation 28 mm cryoballoon by pre-, peri- and postprocedural heart rate acquisition and analysis of clinical outcome. Ninety-one patients could be included in postinterventional follow-up, indicating that cryo-PVI resulted in a significant rise of sinus rate by 16.5% (+ 9.8 ± 0.9 beats/min, p < 0.001) 1 day post procedure compared to preprocedural acquisition. This effect was more pronounced in patients with initial sinus bradycardia (< 60 beats/min.) compared to patients with faster heart rate. Increase of rate was primarily driven by ablation of the right superior pulmonary vein and for a subset of patients, in whom this could be assessed, persisted ≥ 1 year after the procedure. AF recurrence was neither predicted by the magnitude of the initial rate, nor by the extent of rate change, but postprocedural sinus bradycardia was associated with higher recurrence of AF in the year post PVI.

Conclusions

Cryo-PVI causes a significant rise of sinus rate that is more pronounced in subjects with previous sinus bradycardia. Patient follow-up indicates persistence of this effect and suggests an increased risk of AF recurrence in patients with postprocedural bradycardia.

Graphic abstract

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Title: Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation
Authors: Lara Wagner
Fabrice F. Darche
Dierk Thomas
Patrick Lugenbiel
Panagiotis Xynogalos
Svenja Seide
Eberhard P. Scholz
Hugo A. Katus
Patrick A. Schweizer
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Antiarrhythmic Drugs
Atrial Fibrillation
Published in: Clinical Research in Cardiology / Issue 1/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-020-01659-0

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Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation

Abstract

Background

Methods and results

Conclusions

Graphic abstract

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