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Coincidental ganglionated plexus modification during radiofrequency pulmonary vein isolation and post-ablation arrhythmia recurrence.

ΤίτλοςCoincidental ganglionated plexus modification during radiofrequency pulmonary vein isolation and post-ablation arrhythmia recurrence.
Publication TypeJournal Article
Year of Publication2017
AuthorsGiannopoulos, G., Kossyvakis C., Angelidis C., Panagopoulou V., Tsiachris D., Vrachatis D. A., Doudoumis K., Letsas K., Pagoni S., Stefanadis C., Vassilikos V. P., Lekakis J., & Deftereos S.
JournalEuropace
Volume19
Issue12
Pagination1967-1972
Date Published2017 Dec 01
ISSN1532-2092
Λέξεις κλειδιάAction Potentials, Aged, Atrial Fibrillation, Catheter Ablation, Disease-Free Survival, Female, Ganglia, Parasympathetic, Heart Rate, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Odds Ratio, Proportional Hazards Models, Pulmonary Veins, Randomized Controlled Trials as Topic, Recurrence, Risk Factors, Time Factors, Treatment Outcome, Vagus Nerve
Abstract

Aims: Vagal responses (VR) during left atrial ablation for atrial fibrillation (AF) treatment have been reported to be associated with less recurrences, presumably because they are a sign of ganglionated plexi modification. Our objective was to evaluate whether coincidentally elicited VR during left atrial ablation are associated with lower AF recurrence rates.Methods and results: This is a post hoc analysis of a prospective study of 291 patients with paroxysmal AF undergoing radiofrequency pulmonary vein isolation (PVI). Vagal responses were defined as episodes of heart rate <40 bpm or asystole lasting >5 s elicited during energy application. Sixty-eight patients (23.4%) had a VR during ablation. In Kaplan-Meier analysis, mean recurrence-free survival was 449 days (95% confidence interval 411-488) in patients with VR when compared with 435 days (95% confidence interval 415-455) in those without (P = 0.310). The 12-month recurrence rate estimates were 25 and 27%, respectively. In an unadjusted Cox model, VR was associated with an odds ratio for recurrence of 0.77 (95% confidence interval 0.46-1.28).Conclusion: Coincidentally elicited VR during radiofrequency PVI in patients with paroxysmal AF do not appear to be related to lower risk of arrhythmia recurrence. This may mean that, even if a VR is truly a sign of coincidental ablation of a ganglionated plexus, this does not necessarily mean that a therapeutic modification has been effected, at least to a degree associated with clinical benefit.

DOI10.1093/europace/euw309
Alternate JournalEuropace
PubMed ID29194518

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