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Quantification of acute parasympathetic denervation during cryoballoon ablation by using extracardiac vagal stimulation

Osório, Thiago Guimarães; Coutiño, Hugo-Enrique; Iacopino, Saverio; Sieira, Juan; Ströker, Erwin; Martín-Sierra, Cristina; Salghetti, Francesca; Paparella, Gaetano; Aryana, Arash; Varnavas, Varnavas; Terasawa, Muryo; Brugada, Pedro; de Asmundis, Carlo*; Chierchia, Gian-Battista*

Journal of Cardiovascular Medicine: March 2019 - Volume 20 - Issue 3 - p 107–113
doi: 10.2459/JCM.0000000000000760
Research articles: Electrophysiology

Aims The purpose of this study was to systematically quantify the level of acute parasympathetic denervation in a stepwise fashion by means of extracardiac vagal stimulation (ECVS) by positioning a quadripolar catheter in the internal jugular vein, in a cohort of patients undergoing second-generation cryoballoon ablation for paroxysmal atrial fibrillation.

Methods Fifty patients with symptomatic paroxysmal atrial fibrillation, having undergone extracardiac vagal stimulation before and after ablation by means of second-generation cryoballoon second-generation cryoballoon ablation, were included.

Results The extracardiac vagal stimulation performed preablation provoked cardioinhibitory responses in all patients with mean pause duration of 10130.6 ± 3280.0 ms. At the end of the procedure, the VRs were significantly diminished with mean pause of 1687.5 ms ± 2183.7 ms (P = 0.00 compared with the pause before the procedure).

Conclusion The ECVS proved to be a reproducible, feasible and reliable method to quantify the degree of parasympathetic denervation during CB-A. In all patients, significant cardiac parasympathetic denervation could be observed at the end of the procedure. Responses to ECVS were more specific to quantify the vagal denervation than the increase in the heart rate. However larger studies are needed to confirm this observation.

Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium

Correspondence to Gian-Battista Chierchia, MD, PhD, Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels, Belgium Tel: +32 (2) 4776851; fax: +32 (2) 4763446; e-mail:,

Received 31 July, 2018

Revised 20 December, 2018

Accepted 20 December, 2018

© 2019 Italian Federation of Cardiology. All rights reserved.