الفهرس 
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Abstract
Atrial fibrillation is the most prevalent cardiac arrhythmia and a significant public health issue. Recently, radiofrequency current ablation and cryoballoon ablation are frequently used for rhythm control in symptomatic paroxysmal AF patients who are resistant to anti-arrhythmic drugs or even as a first-line rhythm control strategy. Several studies have demonstrated an increase in heart rate and a decrease in heart rate variability after radiofrequency catheter ablation of atrial fibrillation due to vagal denervation.
Aim of the study:
This study aims to assess post paroxysmal AF ablation cardiac autonomic dysfunction and its value after Pulmonary vein isolation while comparing between radiofrequency and cryoballoon ablation techniques.
Patients and methods:
The current study enrolled 40 consecutive patients who underwent paroxysmal AF ablation at Ain Shams University hospitals. Patients were randomized into 2 groups, Radiofrequency ablation guided by 3D mapping (RF group; n=20) and Cryoballoon ablation using 2nd generation balloons (CB group; n=20). Full history, examination and preoperative investigations were performed. Patient follow up was arranged after a 1, 3 and 12 months after the procedure to detect success rate by history taking, surface ECG and Valid 24-hour Holter for heart rate variability analysis which was done for each patient pre ablation, after 1 month, 3 months and 12 months post ablation. Statistical comparison between both groups regarding HRV changes and clinical outcome was done.
Results:
Statistical comparison between the two studied groups (radiofrequency and cryoballoon groups) regarding; Mean age in years, mean BMI in kg/m2, gender, AF duration, AF frequency, EHRA class and AF predisposing factors revealed no significant statistical difference.
The efficacy data in the form of freedom from AF at one year using radiofrequency technique was slightly higher than cryoballoon technique (75% Vs 65% respectively). However, this difference wasn’t statistically significant (P-value 0.490).
The incidence of complications was comparable between the two studied groups (3 cases in RF group Vs 2 cases in CB group).
The cryoballoon procedure had less procedural time and fluoroscopy time than the radiofrequency procedure (P-value<0.001).
During the 3-point follow up of HRV parameters (month-1, month-3 and month-12), changes in time domain and frequency domain parameters persisted for 12 months after both techniques, being more pronounced in RF group than CB group. The change in HRV parameters was in favour of vagal withdrawal and sympathetic dominance (there was a Significant decrease in SDNN, rMSSD and triangular index, on the other hand there was a significant increase in LF/HF).
This persistent change in HRV parameters for 1 year wasn’t associated with deterioration in LV systolic function or increase in left atrial diameter.
There was No significant difference between the studied groups regarding orthostatic hypotension before AF ablation and at the three-point follow up. Also, Gastric hypomotility was reported in one patient in RF group post ablation.
Cryoballoon based pulmonary vein isolation is an effective alternative to radiofrequency ablation in patients suffering from symptomatic drug refractory paroxysmal atrial fibrillation. The cryoballoon procedure is safe with shorter procedural and fluoroscopy times.
HRV interpretation is very important in the follow up of patients with AF ablation and can predict efficient isolation of pulmonary veins in both radiofrequency and cryoballoon techniques.