title: Vagal modification can also help prevent late recurrence of atrial fibrillation after segmental pulmonary vein isolation.
abstract: BACKGROUND
  The relationship between vagal modification and paroxysmal atrial fibrillation (PAF) recurrence after segmental pulmonary vein (PV) isolation (S-PVI) was investigated.
  
  
  RESULTS
  S-PVI was performed in 77 PAF patients using a multielectrode basket or circular catheter to achieve electrical disconnection of all 4 PVs independent of eliminating vagal reflexes. Serial Holter-recordings were obtained at baseline, immediately and 1, 3, 6, and 12 months after S-PVI to analyze the heart rate variability. Fifty-one patients were free from symptomatic PAF (Group A) and 26 had late PAF recurrences (Group B) at 12-month follow-up. Immediately after S-PVI, the root mean square of the successive differences (rMSSD) and high-frequency (HF) power, which reflected parasympathetic nervous activity, were significantly lower in Group A than in Group B (rMSSD: 33.6+/-26.0 vs 60.6+/-23.2 ms, P<0.05; ln HF: 8.73+/-0.84 vs 9.31+/-0.95 ms2, P<0.05). There were no significant differences in the average heart rate or ratio of the low-frequency to HF powers between the 2 groups. By multivariate analysis, only the HF immediately after S-PVI was an independent predictor of PAF recurrence (hazard ratio 1.707, 95% confidence interval 1.057-2.756, P<0.05).
  
  
  CONCLUSIONS
  Vagal modification after S-PVI could also help prevent late recurrence of PAF.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, and Division of Cardiology, Nagoya Dai-ni Red Cross Hospital, Cardivascular Center, Nagoya, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshida
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Murakami
authors.forename: Taro
authors.initials: T
authors.lastname: Okada
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ninomiya
authors.forename: Junji
authors.initials: J
authors.lastname: Toyama
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Naoya
authors.initials: N
authors.lastname: Tsuboi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Muto
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirai
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000517:prevention & control*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012008:Recurrence; D013997:Time Factors; D014630:Vagus Nerve