Vagal Reactions during Cryoballoon-Based Pulmonary Vein Isolation: A Clue for Autonomic Nervous System Modulation?

Figure 1

Vagally mediated asystole during thawing phase of the cryoballoon after a 180-second application at the left superior pulmonary vein ostium in a patient with drug-refractory paroxysmal AF. Note that the progressive sinus rhythm rate decreases followed by a 7.6-second asystole. Sinus rhythm resumed thereafter. Time to pulmonary vein isolation was 26 seconds and CB temperature at PVI time was −27°C. Minimal CB temperature reached was −52°C. After 18 months of follow-up, the patient was free from any atrial arrhythmia recurrence. SC: coronary sinus; VP: pulmonary vein.