title: The difference in autonomic denervation and its effect on atrial fibrillation recurrence between the standard segmental and circumferential pulmonary vein isolation techniques.
abstract: 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.
authors.affiliation: 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
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Murakami
authors.forename: Taro
authors.initials: T
authors.lastname: Okada
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Muto
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: 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*