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Bezold‐Jarisch‐Like Reflex During Radiofrequency Ablation of the Pulmonary Vein Tissues in Patients with Paroxysmal Focal Atrial Fibrillation
Author(s) -
TSAI CHINFENG,
CHEN SHIHANN,
TAI CHINGTAI,
CHIOU CHUENWANG,
PRAKASH V.S.,
YU WENCHUNG,
HSIEH MINGHSIUNG,
DING YUAN,
CHANG MAUSONG
Publication year - 1999
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1999.tb00638.x
Subject(s) - medicine , cardiology , bradycardia , pulmonary vein , atrial fibrillation , sinus bradycardia , ablation , anesthesia , catheter ablation , sinus rhythm , asystole , radiofrequency ablation , paroxysmal atrial fibrillation , heart rate , blood pressure
Pulmonary Vein Ablation‐Induced Bradycardia. Introduction: Information is lacking about the occurrence of radiation‐related proarrhythmic events during application of radiofrequency (RF) energy at (he pulmonary veins in patients with paroxysmal focal atrial fibrillation. The purpose of this study was to assess the theoretical risk of reflex bradycardia and hypotension response during RF ablation of these regions rich in endocardial nerve terminals. Methods and Results: Among the 40 consecutive patients (29 men, 11 women; mean age 65 ± 12 years) with clinically documented frequent attacks of paroxysmal atrial fibrillation who underwent superior pulmonary vein ablation for left local atrial fibrillation, 6 patients (15%) developed bradycardia‐hypotension syndrome during energy delivery. A single atrial fibrillation trigger focus in the left or right superior pulmonary vein was found in 3 and 1 patients, respectively. Two patients had two trigger foci originating from the orifice or proximal part of both superior pulmonary veins. After RF current was applied for a period of 14 ± 10 seconds, 2 patients developed functional rhythm and sinus bradycardia, another 2 patients had profound sinus bradycardia, I patient had two episodes of sudden onset of complete AV block with resultant 9.5‐second a systole, and I patient showed profound sinus bradycardia, transient AV block, and an K‐second asystole due to sinus arrest. Blood pressure fell when any substantial bradyarrhythmias occurred. All 6 patients were free of rhythm disturbances during The postablation follow‐up period (mean 8 ± 2 months). Conclusion: RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia‐hypotension responses. The Bezold‐Jarisch‐like reflex might be the underlying mechanism.