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January 6, 2004CirculationOpen Access

Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation

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Why the study?

Does complete vagal denervation by radiofrequency reduce recurrent atrial fibrillation in patients undergoing circumferential pulmonary vein ablation for paroxysmal atrial fibrillation?

Population

297 patients undergoing circumferential pulmonary vein ablation (CPVA) for paroxysmal atrial fibrillation

Comparison

Complete vagal denervation by radiofrequency… vs Circumferential pulmonary vein ablation without…

Design

Cohort

Follow-up

12 months

Authors

CPCarlo PapponeElectrophysiologyVSVincenzo SantinelliElectrophysiologyFMFrancesco MangusoRoyal National Hospital for Rheumatic Diseases

Discussion

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Implication

Complete vagal denervation associated with lower AF recurrence after ablation; hypothesis-generating and requires randomized confirmation.

Key Points

  • This study aims to evaluate the impact of vagal denervation on the recurrence of atrial fibrillation following circumferential pulmonary vein ablation.
  • Data from 297 patients undergoing circumferential pulmonary vein ablation for paroxysmal atrial fibrillation were analyzed.
  • Complete vagal denervation was defined and achieved in 34.3% of participants.
  • Follow-up lasted for 12 months to assess recurrence rates of atrial fibrillation.
  • Patients with complete vagal denervation had significantly lower recurrence of atrial fibrillation (P=0.0002, log-rank test).
  • Only left atrial isolation percentage and complete vagal denervation were significant predictors of AF recurrence (P<0.001 and P=0.025, respectively).
  • Vagal withdrawal was observed for up to 3 months post-ablation.

Structured PICO

Does complete vagal denervation by radiofrequency reduce recurrent atrial fibrillation in patients undergoing circumferential pulmonary vein ablation for paroxysmal atrial fibrillation?

P
Population
297 patients undergoing circumferential pulmonary vein ablation (CPVA) for paroxysmal atrial fibrillation
I
Intervention
Complete vagal denervation (CVD) by radiofrequency (abolition of all evoked vagal reflexes around all pulmonary vein ostia) adjunctive to circumferential pulmonary vein ablation
C
Comparator
Circumferential pulmonary vein ablation without complete vagal denervation
O
Outcome
Recurrent atrial fibrillation at 12 months

Adjunctive complete vagal denervation during circumferential pulmonary vein ablation significantly reduces the recurrence of paroxysmal atrial fibrillation at 12 months.

Cite This Study

Pappone et al. (2004) studied this question.

synapsesocial.com/papers/69fbd6eddf6507d4845ddb74https://doi.org/10.1161/01.cir.0000112641.16340.c7

Topics

Atrial fibrillationPersistent AF managementAF ablation outcomesAnticoagulation in AF
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  2. 2The wavelength of the cardiac impulse and reentrant arrhythmias in isolated rabbit atrium. The role of heart rate, autonomic transmitters, temperature, and potassium.1986 · 333 citations
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  4. 4Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins1999 · 192 citations
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