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

TLDR

No prior data exist on how autonomic nerve modification influences atrial fibrillation recurrence after circumferential pulmonary vein ablation. This study evaluates whether adding radiofrequency vagal denervation to CPVA reduces recurrence of paroxysmal atrial fibrillation in 297 patients. Vagal denervation was performed by ablating all evoked vagal reflexes around pulmonary vein ostia, achieved in 34.3% of patients, with a 12‑month follow‑up. Adjunctive vagal denervation lowered 12‑month AF recurrence, with heart‑rate variability attenuation lasting up to 3 months and CVD emerging as an independent predictor of reduced recurrence.

Abstract

There are no data to evaluate the relationship between autonomic nerve function modification and recurrent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA). This study assesses the incremental benefit of vagal denervation by radiofrequency in preventing recurrent AF in a large series of patients undergoing CPVA for paroxysmal AF.Data were collected on 297 patients undergoing CPVA for paroxysmal AF. Abligation of all evoked vagal reflexes around all pulmonary vein ostia was defined as complete vagal denervation (CVD) and was obtained in 34.3% of patients. Follow-up ended at 12 months. Heart rate variability attenuation, consistent with vagal withdrawal, was detectable for up to 3 months after CPVA, particularly in patients with reflexes and CVD, who were less likely to have recurrent AF than those without reflexes (P=0.0002, log-rank test). Only the percentage area of left atrial isolation and CVD were predictors of AF recurrence after CPVA (P<0.001 and P=0.025, respectively).This study suggests that adjunctive CVD during CPVA significantly reduces recurrence of AF at 12 months.