Antral pulmonary vein isolation yielded similar rates of freedom from atrial fibrillation in patients with vagal (75%), adrenergic (86%), and random (82%) triggers at 21 months (P=0.51).
Cohort (n=209)
Does antral pulmonary vein isolation (APVI) prevent AF recurrence equally well in patients with vagal, adrenergic, and random paroxysmal atrial fibrillation?
Antral pulmonary vein isolation is equally effective in preventing arrhythmia recurrence in patients with vagal, adrenergic, and random paroxysmal atrial fibrillation without structural heart disease.
Absolute Event Rate: 75% vs 82%
p-value: p=0.51
INTRODUCTION: The prevalence of vagal and adrenergic atrial fibrillation (AF) and the success rate of pulmonary vein isolation (PVI) are not well defined. We investigated the prevalence of vagal and adrenergic AF and the ablation success rate of antral pulmonary vein isolation (APVI) in patients with these triggers compared with patients with random AF. METHODS AND RESULTS: Two hundred and nine consecutive patients underwent APVI due to symptomatic drug refractory paroxysmal AF. Patients were diagnosed as vagal or adrenergic AF if >90% of AF episodes were related to vagal or adrenergic triggers; otherwise, a diagnosis of random AF was made. Clinical, electrocardiogram (ECG), and Holter follow-up was every 3 months in the first year and every 6 months afterward and for symptoms. Of 209 patients, 57 (27%) had vagal AF, 14 (7%) adrenergic AF, and 138 (66%) random AF. Vagal triggers were sleep (96.4%), postprandial (96.4%), late post-exercise (51%), cold stimulus (20%), coughing (7%), and swallowing (2%). At APVI, 94.3% of patients had isolation of all veins. Twenty-five (12%) patients had a second APVI. At a follow-up of 21 +/- 15 months, the percentage of patients free of AF was 75% in the vagal group, 86% in the adrenergic group, and 82% for random AF (P = 0.51). CONCLUSION: In patients with PAF and no structural heart disease referred for APVI, vagal AF is present in approximately one quarter. APVI is equally effective in patients with vagal AF as in adrenergic and random AF.
Rosso et al. (Tue,) conducted a cohort in Symptomatic drug refractory paroxysmal atrial fibrillation without structural heart disease (n=209). Antral pulmonary vein isolation (APVI) vs. Adrenergic and random AF was evaluated on Freedom from atrial fibrillation (p=0.51). Antral pulmonary vein isolation yielded similar rates of freedom from atrial fibrillation in patients with vagal (75%), adrenergic (86%), and random (82%) triggers at 21 months (P=0.51).