Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation

• Published in: Circulation (New York, N.Y.) Vol. 109; no. 3; pp. 327 - 334
• Main Authors: PAPPONE, Carlo, SANTINELLI, Vincenzo, LANG, Christopher, TOMITA, Takeshi, MESAS, Cézar, MASTELLA, Elio, ALFIERI, Ottavio, MAUGUSO, Francesco, VICEDOMINI, Gabriele, GUGLIOTTA, Filippo, AUGELLO, Giuseppe, MAZZONE, Patrizio, TORTORIELLO, Valter, LANDONI, Giovanni, ZANGRILLO, Alberto
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 27.01.2004; American Heart Association, Inc
• Subjects: Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Catheter Ablation; Denervation; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart Rate; Humans; Male; Medical sciences; Middle Aged; Parasympathetic Nervous System - physiopathology; Pulmonary Veins - innervation; Pulmonary Veins - surgery; Reflex; Secondary Prevention; Treatment Outcome; Vagus Nerve - physiopathology; Vagus Nerve - surgery; Arrhythmia; Atrial fibrillation; nervous system, autonomic; Cardiovascular disease; Ablation; Excitability disorder; Pulmonary vessel; Heart disease; Blood vessel; Circulatory system; atrium; Pulmonary vein; Denervation; fibrillation
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000112641.16340.c7

There are no data to evaluate the relationship between autonomic nerve function modification and recurrent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA). This study assesses the incremental benefit of vagal denervation by radiofrequency in preventing recurrent AF in a large series of patients undergoing CPVA for paroxysmal AF. Data were collected on 297 patients undergoing CPVA for paroxysmal AF. Abolition of all evoked vagal reflexes around all pulmonary vein ostia was defined as complete vagal denervation (CVD) and was obtained in 34.3% of patients. Follow-up ended at 12 months. Heart rate variability attenuation, consistent with vagal withdrawal, was detectable for up to 3 months after CPVA, particularly in patients with reflexes and CVD, who were less likely to have recurrent AF than those without reflexes (P=0.0002, log-rank test). Only the percentage area of left atrial isolation and CVD were predictors of AF recurrence after CPVA (P<0.001 and P=0.025, respectively). This study suggests that adjunctive CVD during CPVA significantly reduces recurrence of AF at 12 months.