Prognostic value of cardiac sympathetic nervous system in atrial fibrillation recurrence after catheter ablation

Catheter ablation (CA) of atrial fibrillation (AF) might influence the cardiac sympathetic nervous system (CSNS). We investigated the association between the impact of AF ablation with cryoballoon catheter (CB) and contact force sensing radiofrequency catheter (RF) on CSNS and the late AF recurrence, using cardiac iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in patients with and without heat failure (HF).

One hundred sixty-five paroxysmal AF patients who were scheduled for ablation were enrolled. All patients were randomly assigned to CB or RF. MIBG was performed at baseline and 3 months after ablation and the washout rate change (dWR) was calculated. During the follow-up period of 30±15 months after CA, late AF recurrence (LAR) was observed in 42 (25%) patients without any antiarrhythmic drugs. There was no significant difference in the rate of LAR between CB and RF. dWR was significantly greater in patients with than without LAR (4.5±9.3% vs -1.3±12.4%, p=0.007). LAR was significantly more frequently observed in patients with higher dWR ≧6.9%, which was a fair discriminator for early AF recurrence (AUC; 0.644 by ROC curve analysis), than those with low dWR (AF recurrence free rate; 52% vs 84%, p<0.0001). Higher dWR was independently associated with LAR (adjusted hazard ratio = 4.33, 95%CI [2.30-8.16], p<0.0001, adjusted for age, sex, and left atrial diameter).

Excessive adrenergic tone increase at 3 months after CA might be associated with LAR.Figure1Figure2