PO-02-164 VALUE OF CARDIONEUROABLATION WITH VAGAL DENERVATION CONFIRMED BY VAGUS NERVE STIMULATION ON PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION CATHETER ABLATION

Abstract

Despite good results, Atrial fibrillation(AF) ablation shows a relatively high recurrence rate. Therefore, we sought to verify whether endocardial denervation by cardioneuroablation(CNA) can change the AF recurrence post-pulmonary vein isolation(PVI). To compare the long-term AF recurrence post-PVI versus PVI plus vagal denervation (PVI+CNA) by CNA with vagal denervation confirmation by extracardiac vagal stimulation(ECVS). Case-control study of 127 patients, 104(81.9%) males, 53.7±12 years-old, with paroxysmal 71(55.9%) or persistent 56(44.1%) symptomatic AF, refractory to medications without cardiopathy, LA=39.8±6.8, EF=0.66±0.55. Two equivalent groups were established: PVI alone (55 cases) and PVI+CNA (72 cases). The ECVS was performed by intravenous catheter, near the jugular foramen with 50Hz/50microsec/1V/Kg/up to 70V. Endocardial CNA was biatrial over the four main ganglionated plexus and in the AF-Nests regions tagged by fractionation software. The endpoint of CNA was the elimination of the vagal effect induced by ECVS. PVI was achieved in all cases. ECVS effectively induced a vagal reaction in all PVI+CNA patients, and it was possible to eliminate the vagal effect in 88.9% of cases. In 11.1%, there was a slight residual vagal response. Patients were followed up to 45 months (mean FU=21.4±14.2 and 20.4 ± 14.3 months). Recurrences were 17 in the PVI group, and 4 in the PVI+CNA group: Log-Rank p<0.00, HR:5.38(1.78-16.29,p=0.003). No significant complications occurred. The addition of vagal denervation to PVI, with validation of the vagal denervation by ECVS, significantly increased the success rate of the PVI with a marked reduction in AF relapses without increasing complications.