Abstract 2153: Autonomic Response during Pulmonary Vein Isolation using a Hot Balloon Catheter
There are abundant autonomic ganglions around each pulmonary vein(PV) which are correlated with the genesis of atrial fibrillation. It is well-known that the ablation for each PV isolation (PVI) sometimes induces heart rate change, but poorly analyzed. We carefully examined autonomic response during the extensive ablation around each PV using a hot balloon catheter under general anesthesia. The aim of this study is to examine the difference of heart rate change during each PVI, and to examine if the order of PVI affects the heart rate change during PVI. In consecutive 107 patients, we analyzed the heart rate change and the brady arrhythmia incidence during extensive antrum ablation around each PV using a hot balloon catheter. We performed the ablation around 4PV using a hot balloon catheter at random order. The hot balloon catheter dilated 25–30mm with 10 –15ml saline is wedged into PV and the RF energy is delivered from center coil of the balloon whose temperature is set 70 –75°C. We examined the heart rate response during ablation around each PV. During the 1st ablation around the left superior PV(LSPV), mean HR decreased 58.2±10.90(beat per minutes) to 37.1±29.03 (P<0.01) and bradyarrhythmia event(cardiac arrest due to sinus arrest, SA block or AV block more than 5sec) occurred in 36.5% (19 of 51 patients) of the patients. During the 1st ablation around the right superior PV (RSPV), mean HR increased 60.1±13.46 to 71.8±22.40 (P<0.01) and bradyarrhythmia events occurred in 1 of 35 patients. In the ablation around the LSPV following the RSPV ablation, neither significant HR change nor bradyarrhythmia event was seen. During the ablation around the RSPV following the LSPV application, the mean HR still increased 57.0±10.5 to 67.5±13.90 (P<0.01). These findings suggest that the ganglions around LSPV is parasympathetic dominant and inhibited by the prior ablation around the RSPV, while the ganglions around the RSPV is sympathetic dominant and not be affected by any prior ablation around PVs. We conclude the asymmetricity of the autonomic nervous system exists around the PVs in the patients with atrial fibrillation.