Vagal modification can also help prevent late recurrence of atrial fibrillation after segmental pulmonary vein isolation.
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.
Yoshida
Naoki
N
Department of Cardiology, Nagoya University Graduate School of Medicine, and Division of Cardiology, Nagoya Dai-ni Red Cross Hospital, Cardivascular Center, Nagoya, Japan.
Yamada
Takumi
T
Murakami
Yoshimasa
Y
Okada
Taro
T
Ninomiya
Yuichi
Y
Toyama
Junji
J
Yoshida
Yukihiko
Y
Tsuboi
Naoya
N
Muto
Masahiro
M
Inden
Yasuya
Y
Hirai
Makoto
M
Murohara
Toyoaki
T
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