Effects of circumferential or segmental pulmonary vein ablation for paroxysmal atrial fibrillation on cardiac autonomic function.
BACKGROUND
Circumferential and segmental pulmonary vein ablations are two established treatment strategies for ablation of atrial fibrillation. Both techniques require the application of radiofrequency current at anatomical sites that are close to autonomic ganglia. However, the effects of current pulmonary vein ablation techniques on cardiac autonomic function are unknown.


OBJECTIVE
The purpose of this study was to analyze the short- and long-term effects of circumferential and segmental pulmonary vein ablation on cardiac autonomic function.


METHODS
One hundred patients with highly symptomatic atrial fibrillation were randomly assigned to undergo either circumferential or segmental pulmonary vein ablation. Holter recordings were recorded at baseline and at regular intervals for up to 1 year after ablation. Autonomic function was assessed by deceleration capacity and acceleration capacity of heart rate as well as by standard measures of heart rate variability.


RESULTS
In the circumferential pulmonary vein ablation group, deceleration capacity and acceleration capacity decreased highly significantly from 5.7 +/- 2.1 ms and -8.0 +/- 1.9 ms at baseline to 3.3 +/- 1.8 ms and -5.5 +/- 2.3 ms directly after ablation, respectively (P<.00001). Impairment of deceleration capacity and acceleration capacity was present up to 1 year after ablation. In the segmental pulmonary vein ablation group, deceleration capacity and acceleration capacity decreased from 5.8 +/- 2.0 ms and -7.8 +/- 1.6 ms at baseline to 3.4 +/- 1.2 ms and -6.0 +/- 2.4 ms directly after ablation (P<.00001), respectively. However, deceleration capacity and acceleration capacity returned to baseline values within 1 month.


CONCLUSIONS
Circumferential and segmental pulmonary vein ablations induce an immediate decrease of autonomic function. However, while this decrease is only transient with segmental pulmonary vein ablation, it persists with circumferential pulmonary vein ablation for at least 1 year.
Bauer
Axel
A
I. Medizinische Klinik der Technischen Universität München and Deutsches Herzzentrum München, Munich, Germany.
Deisenhofer
Isabel
I
Schneider
Raphael
R
Zrenner
Bernhard
B
Barthel
Petra
P
Karch
Martin
M
Wagenpfeil
Stefan
S
Schmitt
Claus
C
Schmidt
Georg
G
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001341:Autonomic Nervous System / Q000503:physiopathology*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation* / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome