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Europace Advance Access published online on October 29, 2009
Europace, doi:10.1093/europace/eup330
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

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

Takumi Yamada1,*, Naoki Yoshida2, Yoshimasa Murakami3, Taro Okada3, Yukihiko Yoshida4, Masahiro Muto2, Yasuya Inden2 and Toyoaki Murohara2

1 Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL, USA; 2 Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3 Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; 4 Division of Cardiology, Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan

Aims: This 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 results: Successful 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.

Conclusion: Although additional radiofrequency ablation for AM may be recommended after S-PVI to reduce PAF recurrences, it should be carefully determined after C-PVI.

Key Words: Atrial fibrillation, Pulmonary vein isolation, Autonomic nervous system, Heart rate variability, Radiofrequency catheter ablation

* Corresponding author. Tel: +1 205 975 4724, Fax: +1 205 975 4720, Email: takumi-y{at}fb4.so-net.ne.jp

Manuscript submitted 22 May 2009. Accepted after revision 28 September 2009.


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