Pulmonary vein isolation for vagotonic, adrenergic, and random episodes of paroxysmal atrial fibrillation.
BACKGROUND
Based on the clinical history, paroxysmal atrial fibrillation (PAF) may be classified as vagotonic, adrenergic, or random. It is unclear whether pulmonary vein (PV) isolation is equally effective for these types of PAF.


RESULTS
Segmental ostial ablation to isolate the PVs was performed in 188 consecutive patients (mean age 53 +/- 12 years) with PAF. Based on the clinical history, PAF was classified as random in 136 patients (72%), adrenergic in 30 (16%), and vagotonic in 22 (12%). Three or four PVs were targeted for isolation in all patients, and successful isolation was achieved in 96% of targeted PVs. At 1-year follow-up, 69% of patients with random AF, 83% of patients with adrenergic AF, and 50% of patients with vagotonic AF were free from recurrent episodes of AF in the absence of any antiarrhythmic drug therapy. Vagotonic AF was an independent clinical predictor of recurrent AF (P = 0.03).


CONCLUSIONS
PV isolation has a lower efficacy in patients with vagotonic PAF than in patients with adrenergic or random episodes of PAF, suggesting that the PVs less often play an important role in vagotonic PAF.
Oral
Hakan
H
Division of Cardiology, TC B1 140D, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0311, USA.
Chugh
Aman
A
Scharf
Christoph
C
Hall
Burr
B
Cheung
Peter
P
Veerareddy
Srikar
S
Daneshvar
Gerald F
GF
Pelosi
Frank
F
Morady
Fred
F
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D018340:Receptors, Adrenergic, alpha-1 / Q000502:physiology*; D012008:Recurrence; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014630:Vagus Nerve / Q000503:physiopathology*
D018340:Receptors, Adrenergic, alpha-1