TY - JOUR
T1 - Vagal modification can also help prevent late recurrence of atrial fibrillation after segmental pulmonary vein isolation
AU - Yoshida, Naoki
AU - Yamada, Takumi
AU - Murakami, Yoshimasa
AU - Okada, Taro
AU - Ninomiya, Yuichi
AU - Toyama, Junji
AU - Yoshida, Yukihiko
AU - Tsuboi, Naoya
AU - Muto, Masahiro
AU - Inden, Yasuya
AU - Hirai, Makoto
AU - Murohara, Toyoaki
PY - 2009/4
Y1 - 2009/4
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Autonomic nervous system
KW - Heart rate variability
KW - Radiofrequency catheter ablation
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U2 - 10.1253/circj.CJ-08-0599
DO - 10.1253/circj.CJ-08-0599
M3 - Article
C2 - 19225201
AN - SCOPUS:65649139946
SN - 1346-9843
VL - 73
SP - 632
EP - 638
JO - Circulation Journal
JF - Circulation Journal
IS - 4
ER -