The difference in autonomic denervation and its effect on atrial fibrillation recurrence between the standard segmental and circumferential pulmonary vein isolation techniques.
OBJECTIVE
This study examined the difference in autonomic modification (AM) and its effect on paroxysmal atrial fibrillation (PAF) recurrence between segmental pulmonary vein isolation (S-PVI) and circumferential PVI (C-PVI).


RESULTS
Successful S-PVI or C-PVI with a basket catheter was achieved in 120 consecutive PAF patients. Serial 24 Holter-recordings were obtained before, immediately, and 1, 3, 6, 12 months after the PVI to analyse the heart rate variability (HRV). Nineteen patients were excluded from analysis because of additional ablation for recurrent PAF after successful PVI. Among the residual 101 patients, 33 had PAF recurrences (S-PVI = 44.0%, C-PVI = 21.6%) at 1 year of follow-up. The root mean square of successive differences and high-frequency power reflecting parasympathetic nervous activity were significantly lower in patients with and without PAF recurrences after C-PVI and patients without PAF recurrences after S-PVI than patients with PAF recurrences after S-PVI (P < 0.005-0.0001). However, there were no significant differences in any HRV parameters in the immediate aftermath of PVI among the patients without PAF recurrences after S-PVI and those with and without PAF recurrences after C-PVI.


CONCLUSIONS
Although additional radiofrequency ablation for AM may be recommended after S-PVI to reduce PAF recurrences, it should be carefully determined after C-PVI.
Yamada
Takumi
T
Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, 1530 3rd Avenue S., Birmingham, AL, 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; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*