title: High-frequency stimulation of the atria increases early recurrence following pulmonary vein isolation in patients with persistent atrial fibrillation.
abstract: BACKGROUND
  High-frequency stimulation (HFS) of the atria induces atrial fibrillation (AF) when applied during sinus rhythm and elicits a parasympathetic response when delivered at sites where ganglionated plexi (GPs) are located. However, little is known about its impact after an electrophysiological study.
  
  
  OBJECTIVE
  To evaluate the impact of HFS on the short-term and long-term outcomes after the ablation of persistent AF.
  
  
  METHODS
  Thirty consecutive patients with persistent or long-standing persistent AF were randomly assigned to either receive HFS of the left atrium (n = 15) or not (n = 15) during their electrophysiological studies. Patients receiving HFS were examined to determine whether or not a vagal response was elicited by the HFS at sites where GPs were located before and after conventional pulmonary vein isolation without any ablation targeting the GPs. Patients not receiving the HFS underwent the ablation procedure alone. The rate of recurrence of AF within 3 months of the procedure (early recurrence [ER]) and the frequency of that occurring after that period (late recurrence) were compared between the patient groups.
  
  
  RESULTS
  The incidence of ER occurred more frequently in patients with HFS than in those without (80% vs 40%; P = .015), whereas the occurrence of late recurrence was similar between the 2 groups (27% vs 33%; P = .73). In the HFS group, the number of GPs decreased from 3.4 ± 1.1 to 1.5 ± 0.8 after the pulmonary vein isolation (P < .0001), and the decrease was smaller in the patients experiencing ER than in those without.
  
  
  CONCLUSIONS
  HFS increases the incidence of ER in patients with persistent AF despite a partial GP modification resulting from the pulmonary vein isolation.
authors.affiliation: Department of Cardiology, Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan. rjrgw059@ybb.ne.jp
authors.forename: Akinori
authors.initials: A
authors.lastname: Sairaku
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tatematsu
authors.forename: Mamoru
authors.initials: M
authors.lastname: Nanasato
authors.forename: Haruo
authors.initials: H
authors.lastname: Hirayama
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakano
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery; D006329:Heart Conduction System / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D014463:Ultrasonography; D014630:Vagus Nerve / Q000473:pathology*