Impact of Cardioneuroablation with Vagal Denervation Confirmed by Vagus Nerve Stimulation on Pulmonary Vein Isolation for Atrial Fibrillation Catheter Ablation.

Background: 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). Objective: 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). Methods: 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. Results: 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% of cases, 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 four in the PVI+CNA group: Log-Rank p < 0.00, HR: 5.38 (1.78-16.29, p = 0.003). No major complications occurred. Conclusion: 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. [ABSTRACT FROM AUTHOR]