Coincidental ganglionated plexus modification during radiofrequency pulmonary vein isolation and post-ablation arrhythmia recurrence.
Τίτλος | Coincidental ganglionated plexus modification during radiofrequency pulmonary vein isolation and post-ablation arrhythmia recurrence. |
Publication Type | Journal Article |
Year of Publication | 2017 |
Authors | Giannopoulos, 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. |
Journal | Europace |
Volume | 19 |
Issue | 12 |
Pagination | 1967-1972 |
Date Published | 2017 Dec 01 |
ISSN | 1532-2092 |
Λέξεις κλειδιά | Action 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. |
DOI | 10.1093/europace/euw309 |
Alternate Journal | Europace |
PubMed ID | 29194518 |