Vagal modification can also help prevent late recurrence of atrial fibrillation after segmental pulmonary vein isolation

Naoki Yoshida, Takumi Yamada, Yoshimasa Murakami, Taro Okada, Yuichi Ninomiya, Junji Toyama, Yukihiko Yoshida, Naoya Tsuboi, Masahiro Muto, Yasuya Inden, Makoto Hirai, Toyoaki Murohara

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13 Scopus citations


Background: The relationship between vagal modification and paroxysmal atrial fibrillation (PAF) recurrence after segmental pulmonary vein (PV) isolation (S-PVI) was investigated. Methods and Results: S-PVI was performed in 77 PAF patients using a multielectrode basket or circular catheter to achieve electrical disconnection of all 4 PVs independent of eliminating vagal reflexes. Serial Holter-recordings were obtained at baseline, immediately and 1, 3, 6, and 12 months after S-PVI to analyze the heart rate variability. Fifty-one patients were free from symptomatic PAF (Group A) and 26 had late PAF recurrences (Group B) at 12-month follow-up. Immediately after S-PVI, the root mean square of the successive differences (rMSSD) and high-frequency (HF) power, which reflected parasympathetic nervous activity, were significantly lower in Group A than in Group B (rMSSD: 33.6±26.0 vs 60.6±23.2 ms, P<0.05; ln HF: 8.73±0.84 vs 9.31±0.95 ms2, P<0.05). There were no significant differences in the average heart rate or ratio of the low-frequency to HF powers between the 2 groups. By multivariate analysis, only the HF immediately after S-PVI was an independent predictor of PAF recurrence (hazard ratio 1.707, 95% confidence interval 1.057-2.756, P<0.05). Conclusions: Vagal modification after S-PVI could also help prevent late recurrence of PAF.

Original languageEnglish (US)
Pages (from-to)632-638
Number of pages7
JournalCirculation Journal
Issue number4
StatePublished - Apr 2009
Externally publishedYes


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


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