title: Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation.
abstract: BACKGROUND
  There are no data to evaluate the relationship between autonomic nerve function modification and recurrent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA). This study assesses the incremental benefit of vagal denervation by radiofrequency in preventing recurrent AF in a large series of patients undergoing CPVA for paroxysmal AF.
  
  
  RESULTS
  Data were collected on 297 patients undergoing CPVA for paroxysmal AF. Abolition of all evoked vagal reflexes around all pulmonary vein ostia was defined as complete vagal denervation (CVD) and was obtained in 34.3% of patients. Follow-up ended at 12 months. Heart rate variability attenuation, consistent with vagal withdrawal, was detectable for up to 3 months after CPVA, particularly in patients with reflexes and CVD, who were less likely to have recurrent AF than those without reflexes (P=0.0002, log-rank test). Only the percentage area of left atrial isolation and CVD were predictors of AF recurrence after CPVA (P<0.001 and P=0.025, respectively).
  
  
  CONCLUSIONS
  This study suggests that adjunctive CVD during CPVA significantly reduces recurrence of AF at 12 months.
authors.affiliation: Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy. carlo.pappone@hsr.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vicedomini
authors.forename: Filippo
authors.initials: F
authors.lastname: Gugliotta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Augello
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.forename: Valter
authors.initials: V
authors.lastname: Tortoriello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Christopher
authors.initials: C
authors.lastname: Lang
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomita
authors.forename: Cézar
authors.initials: C
authors.lastname: Mesas
authors.forename: Elio
authors.initials: E
authors.lastname: Mastella
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D003714:Denervation; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D012018:Reflex; D055502:Secondary Prevention; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology / Q000601:surgery