Efficacy and Drug-Related Complications of Anticholinergic Drugs for Vagal Reaction Prevention During Pulsed Field Ablation.
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Vetta Giampaolo, Della Rocca Domenico G, Magnocavallo Michele, Richard-Vitton Robin, Almorad Alexandre, Betancur Andres, Sorgente Antonio, Polselli Marco, Marcon Lorenzo, Mohanty Sanghamitra, Del Monte Alvise, Lombardo Ilenia, Pannone Luigi, Mouram Sahar, Stroker Erwin, Gianni Carola, La Fazia Vincenzo Mirco, Bianchi Stefano, Doundoulakis Ioannis, Overeinder Ingrid, Audiat Charles, Nakasone Kazutaka, Bala Gezim, Combes Stephane, Sarkozy Andrea, Sieira Juan, Boveda Serge, Rossi Pietro, Natale Andrea, de Asmundis Carlo, Chierchia Gian-Battista, HRMC Investigators
Аннотация
OBJECTIVES: The aim of this study was to compare the effectiveness of 2 different anticholinergic (AC) medications, namely glycopyrrolate (GLY) or atropine (ATP), for VR prophylaxis in patients undergoing PVI via a pentaspline PFA catheter.
METHODS: Consecutive patients with atrial fibrillation undergoing first-time PVI with PFA were prospectively enrolled at 4 centers between April 2023 and March 2024. Intravenous GLY 0.2 mg (Group GLY) or ATP 1 mg (Group ATP) were administered prophylactically before transseptal access. Clinically relevant VRs included sinus bradycardia (<40 beats/min), asystole (>6 seconds), atrioventricular block, and the need for temporary backup pacing. The incidence of periprocedural VRs was compared with that of patients without prophylactic AC drug administration (Group noAC). Drug-related adverse events were compared between the 2 AC drugs.
RESULTS: We enrolled 240 patients (age 61 ± 12 years, 60.0% male) (GLY: n = 80; ATP: n = 80; noAC: n = 80). Intraprocedural VRs were observed in 65 patients (27.1%). GLY and ATP effectively reduced overall VRs (GLY: 7.5% vs ATP: 11.3% vs noAC: 62.5%; P < 0.001), asystole (GLY: 1.3% vs ATP: 2.5% vs noAC: 33.8%; P < 0.001), and need for temporary backup pacing (GLY: 1.3% vs ATP: 5.0% vs noAC: 23.8%; P < 0.001). The risk of overall drug-related adverse events (8.8% vs 0%; P = 0.007) and drug-induced atrial fibrillation (5% vs 0%; P = 0.043) was significantly higher with ATP.
CONCLUSIONS: Prophylactic AC drug administration effectively prevented clinically relevant VRs in patients undergoing PVI with PFA. Both AC drugs were equally highly effective, but ATP showed a significantly higher rate of drug-induced adverse events.