Combined effect of pulmonary vein isolation and ablation of cardiac autonomic nerves for atrial fibrillation.
This study was designed to determine whether endocardial high-frequency stimulation at the pulmonary vein (PV) antrums can localize cardiac autonomic ganglionated plexi (GP) and whether ablation at these sites can evoke a vagal response and provide a long-term benefit after PV isolation (PVI) for atrial fibrillation (AF). Radiofrequency ablation of each PV antrum was performed in 21 patients with paroxysmal AF (n = 17) or persistent (n = 4) AF. In 8 patients with paroxysmal AF, a ring electrode catheter was placed at each PV antrum. High-frequency stimulation prolonged the R-R interval in 6 of 8 patients at the left superior (LS) PV, in 3 of 8 patients at the left inferior (LI) PV, in 3 of 8 patients at the right superior (RS) PV, and in 3 of 8 patients at the right inferior (RI) PV. A decrease in sinus rate > 20% was observed in 4 of 21 patients during LS PVI, in 2 of 21 patients during RS PVI, and in 1 of 2 patients during RI PVI. Atrioventricular block or a > 5 second pause was observed in 5 of 21 patients during LS PVI. AF recurred during the follow-up period in 5 of the 16 patients (31%) who had no atrioventricular block or > 5 second pause during PVI but did not recur in 5 patients in whom atrioventricular block or a > 5 second pause developed during PVI. GP can be identified by endocardial stimulation. The AF recurrence rate is decreased when a vagal response is achieved by radiofrequency ablation.
Ohkubo
Kimie
K
Department of Cardiovascular Disease, Nihon University School of Medicine, Tokyo, Japan.
Watanabe
Ichiro
I
Okumura
Yasuo
Y
Ashino
Sonoko
S
Kofune
Masayoshi
M
Takagi
Yasuhiro
Y
Yamada
Takeshi
T
Kofune
Tatsuya
T
Hashimoto
Kenichi
K
Shindo
Atsushi
A
Sugimura
Hidezou
H
Nakai
Toshiko
T
Kunimoto
Satoshi
S
Kasamaki
Yuji
Y
Hirayama
Atsushi
A
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D017776:Autonomic Pathways / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006321:Heart / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000502:physiology*; D055502:Secondary Prevention