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Atrial ganglionated plexi modification combined with pulmonary vein isolation in athletes with highly symptomatic atrial fibrillation and baseline bradycardia
Session:
Comunicações Orais (Sessão 13) - Arritmias 3 - Fibrilhação auricular
Speaker:
Mário Martins Oliveira
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mário Martins Oliveira; Pedro s Cunha; Sérgio Laranjo; Mauricio Scanavacca; Guilherme Portugal; Bruno Valente; Ana Lousinha; André Grazina; Hipolito Reis; Ana s Trindade; Claudia Mendes; Margarida Paulo; Rui c Ferreira
Abstract
<p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:#222222">Experimental and clinical studies have established an important influence of autonomic nervous system activity on the initiation and maintenance of atrial fibrillation (AF). Long-term endurance sports training is associated with a higher risk of developing AF, due to increased vagal tone, acting synergistically with sympathetic hyperactivity during intense exercise, creating the electrophysiological conditions for the occurrence of AF episodes. In this population, the use of antiarrhythmic drugs (AAD) contributes to more pronounced bradycardia and a decrease in exercise performance. <strong>Aim</strong>: evaluate the safety and success rates of combining pulmonary vein isolation (PVI) and anatomic modification of the major left atrial ganglionated plexi (GP) in athletes with AF and sinus bradycardia. <strong>Methods:</strong> 22 consecutive patients (46±11 years; 17 male; left atrial volume 32-56 ml/m2; left ventricular ejection fraction >50%; CHADSVASc 0-2; AAD used as “pill in the pocket”) undergoing PVI + atrial GP ablation with radiofrequency (RF) due to AF (paroxysmal AF – 77,3%) and pronounced rest bradycardia (<50 bpm). The primary outcome was the freedom from AF or sustained atrial tachycardia during 12-months follow-up verified by ECG (every 3 months or if symptoms), external event recorder (blanking period), and 24h-Holter (at 3 and 12 months). <strong>Results:</strong> Patients underwent successful PVI (4-5 PV) and RF modification of the four GP in the vicinity of the PV. All but one had extreme bradycardia or pauses during RF application in GP locations. The average procedure time was 150 min and fluoroscopy time 15 min. The duration of RF (20-35W) was 40±10 min. There was a pericardial effusion drained in the laboratory, with no other acute complications. The mean heart rate (24h-Holter recording) changed from 53 bpm to 67 bpm, before and 3 months after ablation, respectively (p=0.03). At 12-month follow-up, maintenance of sinus rhythm was 86,3%, with an EHRA score for AF-related symptoms of I-II. <strong>Conclusion:</strong> Left atrial neuromodulation </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">as an adjunctive procedure to PVI may provide benefits in AF suppression for the treatment of athletes suffering from AF and sinus bradycardia.</span></span></span></span></span></span></p> <p> </p>
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