Vagal paroxysmal atrial fibrillation: prevalence and ablation outcome in patients without structural heart disease.
BACKGROUND
The prevalence of vagal and adrenergic atrial fibrillation (AF) and the success rate of pulmonary vein isolation (PVI) are not well defined. We investigated the prevalence of vagal and adrenergic AF and the ablation success rate of antral pulmonary vein isolation (APVI) in patients with these triggers compared with patients with random AF.


RESULTS
Two hundred and nine consecutive patients underwent APVI due to symptomatic drug refractory paroxysmal AF. Patients were diagnosed as vagal or adrenergic AF if >90% of AF episodes were related to vagal or adrenergic triggers; otherwise, a diagnosis of random AF was made. Clinical, electrocardiogram (ECG), and Holter follow-up was every 3 months in the first year and every 6 months afterward and for symptoms. Of 209 patients, 57 (27%) had vagal AF, 14 (7%) adrenergic AF, and 138 (66%) random AF. Vagal triggers were sleep (96.4%), postprandial (96.4%), late post-exercise (51%), cold stimulus (20%), coughing (7%), and swallowing (2%). At APVI, 94.3% of patients had isolation of all veins. Twenty-five (12%) patients had a second APVI. At a follow-up of 21 +/- 15 months, the percentage of patients free of AF was 75% in the vagal group, 86% in the adrenergic group, and 82% for random AF (P = 0.51).


CONCLUSIONS
In patients with PAF and no structural heart disease referred for APVI, vagal AF is present in approximately one quarter. APVI is equally effective in patients with vagal AF as in adrenergic and random AF.
Rosso
Raphael
R
Department Of Cardiology, Royal Melbourne Hospital, Australia.
Sparks
Paul B
PB
Morton
Joseph B
JB
Kistler
Peter M
PM
Vohra
Jitendra K
JK
Halloran
Karen
K
Medi
Caroline
C
Kalman
Jonathan M
JM
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*
D000925:Anticoagulants