Vagal modification can be a valid predictor of late recurrence of paroxysmal atrial fibrillation independent of the pulmonary vein isolation technique.
BACKGROUND
Vagal denervation during pulmonary vein isolation (PVI) may reduce paroxysmal atrial fibrillation (PAF) recurrences. Valid predictors of late PAF recurrence after PVI were examined.


RESULTS
Successful segmental (S-PVI) or circumferential PVI (C-PVI) was achieved in 120 consecutive PAF patients. The 24-h Holter recordings were obtained before and after PVI. Logistic regression analysis was performed to determine independent predictors of PAF recurrence among the patient characteristics, PVI technique and heart rate variability (HRV). Of the 120 patients, 19 were excluded from analysis because of additional ablation for recurrent PAF after successful PVI. Among the remaining 101 patients, 68 were free from PAF (Group-I) and 33 had late PAF recurrences (Group-II) at 1-year follow-up. The incidence of PAF recurrence and conduction recovery in isolated PVs revealed in the second session was significantly lower for C-PVI (21.6% and 28.1%) than for S-PVI (44.0% and 58.3%) (P<0.05). There were no significant differences in the HRV high-frequency component (HF) reflecting parasympathetic activity or the low/high frequency component (LF/HF) reflecting sympathetic activity between the 2 techniques. By multivariate analysis, the PVI technique, HF and LF/HF were independent predictors of PAF recurrence (P<0.05).


CONCLUSIONS
Vagal denervation may prevent late PAF recurrence independent of the PVI technique.
Yamada
Takumi
T
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
Yoshida
Naoki
N
Murakami
Yoshimasa
Y
Okada
Taro
T
Yoshida
Yukihiko
Y
Muto
Masahiro
M
Inden
Yasuya
Y
Murohara
Toyoaki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014628:Vagotomy; D014630:Vagus Nerve / Q000503:physiopathology / Q000601:surgery*