title: The impact of vagotonic, adrenergic, and random type of paroxysmal atrial fibrillation on left atrial ablation outcomes.
abstract: BACKGROUND
  Accumulating data have shown that the autonomic nervous system is strongly implicated in the genesis of atrial fibrillation (AF). The aim of this study was to assess the efficacy of a single ablation procedure in patients with vagotonic, adrenergic and random type of paroxysmal AF.
  
  
  RESULTS
  The clinical records of consecutive patients with symptomatic, drug-refractory paroxysmal AF who underwent pulmonary vein antral isolation were analysed. The study population consisted of 104 patients (64 males, mean age 57.9 ± 10.9 years) with paroxysmal AF. Based on AF triggers, patients were classified in those with vagotonic (31.7%), adrenergic (17.3%) and random AF (51%). Subjects with adrenergic and random AF tended to be older (p: 0.104) and displayed a higher incidence of hypertension (p: 0.088) compared with those with vagotonic AF. Following a mean follow-up period of 14.7 ± 7.4 months, 74 patients were free from arrhythmia recurrence (71.2%). Late arrhythmia recurrence (>3 months from the index procedure) occurred in 33.3%, 16.7% and 30.2% of patients with vagotonic, adrenergic and random AF, respectively (p: 0.434). Cox regression analysis showed that early AF recurrence [hazard ratio (HR) 15.76; 95% confidence interval (CI) 5.456-45.566, p: <0.001], left atrial volume (HR 0.969; 95% CI 0.942-0.996, p: 0.025) and statin use (HR 6.828; 95% CI 2.078-22.437 p: 0.002) were independent predictors of late arrhythmia recurrence.
  
  
  CONCLUSIONS
  In this study cohort, the type of paroxysmal AF was not associated with arrhythmia recurrence following left atrial ablation.
authors.affiliation: 2(nd) Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Efremidis
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Letsas
authors.forename: Louiza
authors.initials: L
authors.lastname: Lioni
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kossyvakis
authors.forename: Spyros
authors.initials: S
authors.lastname: Tsikrikas
authors.forename: Charalampos
authors.initials: C
authors.lastname: Charalampous
authors.forename: George
authors.initials: G
authors.lastname: Kollias
authors.forename: Sotirios
authors.initials: S
authors.lastname: Xydonas
authors.forename: Andreas
authors.initials: A
authors.lastname: Synetos
authors.forename: Antonios
authors.initials: A
authors.lastname: Sideris
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011941:Receptors, Adrenergic / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology*
chemical_list: D011941:Receptors, Adrenergic
keywords: Adrenergic; Atrial fibrillation; Autonomic tone; Catheter ablation; Vagotonic