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Role of combined pulmonary vein isolation with left atrial ganglionated plexus ablation in paroxysmal atrial fibrillation and sinus bradycardia
Session:
Sessão de Posters 13 - Ablação de fibrilhação auricular
Speaker:
Sofia B. Paula
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Sofia B. Paula; Margarida Figueiredo; Sofia Jacinto; Ana Raquel Santos; Hélder Santos; André Viveiros Monteiro; Guilherme Portugal; Ana Lousinha; Bruno Valente; Paulo Osório; Pedro Silva Cunha; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Atrial fibrillation (AF) is the most common sustained arrhythmia. It is a complex clinical entity, in which remains difficult to maintain durably of ablation success over time. <span style="background-color:white">The role of the autonomic nervous system in the onset and maintenance of AF has been well established, and, therefore, autonomic modulation strategies, including targeting atrial ganglionated plexi (GPs) with catheter ablation, have emerged as new targets. In patients with paroxysmal AF (PAF), particularly in those with long-term sports training, the use of beta-blockers or antiarrhythmic medication is limited by pronounced bradycardia. We aimed to evaluate the safety and efficacy of combining pulmonary vein isolation (PVI) with GP modification in a selected cohort of patients. <strong>Methods:</strong> </span></span><span style="color:black">Multicentre retrospective study performed in patients with PAF and moderate sinus bradycardia submitted do PVI and left atrial anatomically-based GP ablation in the same procedure. <strong>Results: </strong></span><span style="color:black">We screened 31 patients (age 55.4 (±13.2) years, 80.6% males)</span><span style="color:black">. Cardiovascular risk factors were arterial systemic hypertension (35.5%), dyslipidaemia (32.3%), obstructive sleep apnoea (45.2%), and excessive weight (90%). Younger patients (39%) had regular moderate to intensive physical exercise. The mean indexed left atrial volume was 34.72 (</span><span style="font-family:"Times New Roman",serif"><span style="color:black">±</span></span><span style="color:black">6.58) ml/m<sup>2</sup> and the CHA<sub>2</sub>DS<sub>2</sub>VASc score was 0 in 51.6% of the cases. All cases were performed with 3D electroanatomic CARTO (Biosense) or ENSITE (Abbott) systems. Mean RF time was 31.9 (±13.7) min for PVI and 14.8 (±5.29) min for the GP. Mean fluoroscopy time was 10.9 (±7.6) min. All the procedures were successful. There were no major complications. Holter recordings showed a mean heart rate of 64.3 (±11.5) bpm before ablation, and 67.1 (±10.9), 71.8 (±5.1) and 69.6 (±6.1) bpm, 3, 6 and 12 months after ablation, respectively. The difference between the mean HR before and 3 months after the procedure was not statistically significant (p= 0.2), but after 6 and 12 months there was a statistically significant HR increase (p= 0.004 and p= 0.013, respectively). After 1-year of follow-up, there were 13% of atrial arrhythmias (AF – 9,8%; atrial flutter -3,2%) episodes, with around 85% of the patients maintaining sinus rhythm without antiarrhythmics. <strong>Conclusion: </strong>The combination of PVI and left atrial GP modulation is a safe and efficient procedure, allowing a significant increase in heart rate, and suppressing AF in the large majority of patients without the need for antiarrhythmics.</span></span></span></p>
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