PO-01-032 CLINICAL AND PHYSIOLOGIC OUTCOMES OF COMPUTED TOMOGRAPHY-GUIDED CARDIONEUROABLATION VERSUS STANDARD ABLATION FOR ATRIAL FIBRILLATION

Abstract

Cardioneuroablation (CNA) of ganglionated plexi (GP) is increasingly recognized for its potential to improve atrial fibrillation (AF) ablation outcomes. Computed tomography (CT)-identified epicardial adipose tissue (EAT) represents a promising approach to localizing GP. However, the clinical efficacy of CT-guided CNA and its utility in combination with standard AF ablation is unclear. To characterize the physiologic and clinical outcomes of CT-guided CNA performed at the time of standard AF ablation. The CNA cohort included patients with AF who underwent CT to identify EAT corresponding with GP anatomic regions, which was merged with electroanatomic right and left atrial maps at the time of the procedure. CNA targeting regions of EAT was performed in addition to standard AF ablation. Vagal-induced AF was defined as the presence of recurrent vagal triggers by history or progressive bradycardia preceding AF on continuous electrocardiographic monitoring. The control group consisted of patients who underwent AF ablation without CNA. AF outcomes were assessed after a 3-month post-procedure blanking period. Mean heart rate and heart rate variability were determined via insertable subcutaneous rhythm monitors. The CNA cohort (n=19), was similar to the standard ablation cohort (n=129) in regard to proportion of females (53% vs. 46%, p=0.6), age (69±6 vs. 69±8 years, p=0.7), rate of prior AF ablation (32% vs. 32%, p=1.0), prevalence of persistent AF (42% vs 39%, p=0.5) and CHA2DS2-VASc scores (3.2±1.1 vs. 2.5±1.5, p=0.1). During follow-up, the mean heart rate did not differ between cohorts, but heart rate variability was significantly lower in the CNA cohort (Figure 1A and 1B). Over a median follow-up period of 430 days (IQR 199-845), atrial flutter or AF recurred at the same rate in the CNA cohort compared to the standard ablation cohort (32% vs. 34%, p=0.8). Patients with a history of vagal-induced AF who underwent CNA (n=8, 42%) had a trend toward a lower rate of recurrence than the control group (13% vs. 34%, p=0.2) and than the CNA patients without vagal-induced AF (13% vs 45%, p=0.1). CT-guided CNA results in reduced heart rate variability without affecting mean heart rate. The rate of AF recurrence overall in the CNA group was not different compared to standard AF ablation. CNA may specifically benefit patients with vagal-induced AF. Further studies are needed to define the role of CT-guided CNA in AF ablation.