Pulmonary Vein Isolation and Beyond: Predictive Value of Vagal Reactions in Second Generation Cryoballoon Ablation for the Outcome of Persistent Atrial Fibrillation

Abstract Background Cryoballoon ablation (CBA) is gaining increasing acceptance in the treatment of persistent (per) atrial fibrillation (AF). The cardiac autonomic nervous system (ANS) plays a pivotal role in regulation of AF. Objective We evaluated the impact of vagal reactions (VRs), as a surrogate marker for ANS modulation, on the outcome of CBA in perAF. Methods 250 consecutive patients (pts) (63.9±10.0 years old, 70% male) undergoing primary second generation (2G) CBA for perAF were studied. VRs were defined as: bradycardia Results VRs were recorded in 61 (24%) pts. These pts showed a significantly reduced recurrence rate of AF (5%) compared to those without VRs (log-rank p Conclusion VR is an independent predictor for AF-free survival after CBA of persistent AF.