The difference in autonomic denervation and its effect on atrial fibrillation recurrence between the standard segmental and circumferential pulmonary vein isolation techniques

Takumi Yamada, Naoki Yoshida, Yoshimasa Murakami, Taro Okada, Yukihiko Yoshida, Masahiro Muto, Yasuya Inden, Toyoaki Murohara

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

AimsThis 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).Methods and resultsSuccessful 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.ConclusionAlthough additional radiofrequency ablation for AM may be recommended after S-PVI to reduce PAF recurrences, it should be carefully determined after C-PVI.

Original languageEnglish (US)
Pages (from-to)1612-1619
Number of pages8
JournalEuropace
Volume11
Issue number12
DOIs
StatePublished - Dec 2009
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Autonomic nervous system
  • Heart rate variability
  • Pulmonary vein isolation
  • Radiofrequency catheter ablation

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