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Vagal Response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation
Abstract Background The role of autonomic innervation around the pulmonary vein (PV) antrum in the genesis of atrial fibrillation (AF) has been demonstrated but the characteristics of radiofrequency induced vagal response (VR) in the PV antrum and its clinical impact on pulmonary vein isolation (PVI...
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| Published in: | International journal of cardiology 2016-05, Vol.211, p.7-13 |
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| creator | Qin, Mu Liu, Xu Jiang, Wei-Feng Wu, Shao-Hui Zhang, Xiao-Dong Po, Sunny |
| description | Abstract Background The role of autonomic innervation around the pulmonary vein (PV) antrum in the genesis of atrial fibrillation (AF) has been demonstrated but the characteristics of radiofrequency induced vagal response (VR) in the PV antrum and its clinical impact on pulmonary vein isolation (PVI) for paroxysmal AF need to be further elucidated. Method Of 995 consecutive patients with symptomatic paroxysmal AF undergoing PVI at a single center over a 2-year period, 516 met exclusion criteria and the remaining 479 patients, 156 positive VR (PVR) and 323 negative VR (NVR), underwent 12 months follow-up. The primary endpoint was freedom from AF or other sustained atrial tachycardia (AT), verified by monthly visits and electrocardiographic monitoring. The frequency-domain analysis was performed to evaluated the autonomic activity before and after procedure. Results VR was most commonly elicited during PVI at the LSPV roof (65.4%) and anterior RSPV (44.9%, with a > 5 s sinus pause in 37/70 [52.8%] cases). Compared with the NVR group, ablation was associated with reduced AF recurrence at 12 months in the PVR (hazard ratio: 0.53, 95% confidence interval: 0.22–0.89). Furthermore, the PVR group showed a significantly abbreviated AF cycle length at the left PV, and significantly lower HF and LF parameters with stable LF/HF ratio during follow-up. Conclusion Complete elimination of vagal response, most commonly elicited by radiofrequency application around the roof of LSPV and anterior RSPV, appeared associated with reduced 12-month recurrence of AF and with marked heart rate variability changes consistent with autonomic nervous withdrawal. |
| doi_str_mv | 10.1016/j.ijcard.2016.02.116 |
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Method Of 995 consecutive patients with symptomatic paroxysmal AF undergoing PVI at a single center over a 2-year period, 516 met exclusion criteria and the remaining 479 patients, 156 positive VR (PVR) and 323 negative VR (NVR), underwent 12 months follow-up. The primary endpoint was freedom from AF or other sustained atrial tachycardia (AT), verified by monthly visits and electrocardiographic monitoring. The frequency-domain analysis was performed to evaluated the autonomic activity before and after procedure. Results VR was most commonly elicited during PVI at the LSPV roof (65.4%) and anterior RSPV (44.9%, with a > 5 s sinus pause in 37/70 [52.8%] cases). Compared with the NVR group, ablation was associated with reduced AF recurrence at 12 months in the PVR (hazard ratio: 0.53, 95% confidence interval: 0.22–0.89). Furthermore, the PVR group showed a significantly abbreviated AF cycle length at the left PV, and significantly lower HF and LF parameters with stable LF/HF ratio during follow-up. Conclusion Complete elimination of vagal response, most commonly elicited by radiofrequency application around the roof of LSPV and anterior RSPV, appeared associated with reduced 12-month recurrence of AF and with marked heart rate variability changes consistent with autonomic nervous withdrawal.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2016.02.116</identifier><identifier>PMID: 26963618</identifier><language>eng</language><publisher>Netherlands: Elsevier Ireland Ltd</publisher><subject>Aged ; Atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Autonomic nervous system ; Cardiovascular ; Catheter Ablation - methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulmonary vein isolation ; Pulmonary Veins - innervation ; Pulmonary Veins - physiopathology ; Pulmonary Veins - surgery ; Vagal response ; Vagus Nerve - physiopathology ; Vagus Nerve - surgery</subject><ispartof>International journal of cardiology, 2016-05, Vol.211, p.7-13</ispartof><rights>2016 Elsevier Ireland Ltd</rights><rights>Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c516t-e034610aa5af5165c2b0b2f3979a574240464042ba8c72a94544f8de3cc7578f3</citedby><cites>FETCH-LOGICAL-c516t-e034610aa5af5165c2b0b2f3979a574240464042ba8c72a94544f8de3cc7578f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26963618$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qin, Mu</creatorcontrib><creatorcontrib>Liu, Xu</creatorcontrib><creatorcontrib>Jiang, Wei-Feng</creatorcontrib><creatorcontrib>Wu, Shao-Hui</creatorcontrib><creatorcontrib>Zhang, Xiao-Dong</creatorcontrib><creatorcontrib>Po, Sunny</creatorcontrib><title>Vagal Response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Abstract Background The role of autonomic innervation around the pulmonary vein (PV) antrum in the genesis of atrial fibrillation (AF) has been demonstrated but the characteristics of radiofrequency induced vagal response (VR) in the PV antrum and its clinical impact on pulmonary vein isolation (PVI) for paroxysmal AF need to be further elucidated. Method Of 995 consecutive patients with symptomatic paroxysmal AF undergoing PVI at a single center over a 2-year period, 516 met exclusion criteria and the remaining 479 patients, 156 positive VR (PVR) and 323 negative VR (NVR), underwent 12 months follow-up. The primary endpoint was freedom from AF or other sustained atrial tachycardia (AT), verified by monthly visits and electrocardiographic monitoring. The frequency-domain analysis was performed to evaluated the autonomic activity before and after procedure. Results VR was most commonly elicited during PVI at the LSPV roof (65.4%) and anterior RSPV (44.9%, with a > 5 s sinus pause in 37/70 [52.8%] cases). Compared with the NVR group, ablation was associated with reduced AF recurrence at 12 months in the PVR (hazard ratio: 0.53, 95% confidence interval: 0.22–0.89). Furthermore, the PVR group showed a significantly abbreviated AF cycle length at the left PV, and significantly lower HF and LF parameters with stable LF/HF ratio during follow-up. Conclusion Complete elimination of vagal response, most commonly elicited by radiofrequency application around the roof of LSPV and anterior RSPV, appeared associated with reduced 12-month recurrence of AF and with marked heart rate variability changes consistent with autonomic nervous withdrawal.</description><subject>Aged</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Autonomic nervous system</subject><subject>Cardiovascular</subject><subject>Catheter Ablation - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Pulmonary vein isolation</subject><subject>Pulmonary Veins - innervation</subject><subject>Pulmonary Veins - physiopathology</subject><subject>Pulmonary Veins - surgery</subject><subject>Vagal response</subject><subject>Vagus Nerve - physiopathology</subject><subject>Vagus Nerve - surgery</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqFUsuO1DAQtBCInV34A4R85JJgO3accEBCK2CRVkLidbUcpzN4SOxgJyuGP-Cv6SELBy57sFpuV1dZVU3IE85Kznj9_FD6g7OpLwXeSiZKzut7ZMcbLQuulbxPdvigCyV0dUbOcz4wxmTbNg_Jmajbuqp5syO_vti9HekHyHMMGWi_Jh_2dF7HKQabjvQGfKA-x9EuPoYXiCwSuLgP_if01C-Zuq82WbdA8nnxLlMbsD_No3d_RjJFgjEGoLNN8ccxT6hnl-SxDL5LftyoH5EHgx0zPL6tF-Tzm9efLq-K6_dv312-ui6c4vVSAKtkzZm1yg7YUE50rBND1erWKi2FZLLGIzrbOC1sK5WUQ9ND5ZxWuhmqC_Js451T_L5CXszkswP8RYC4ZsMbzlsUadTdUN1wJQVnNULlBnUp5pxgMHPyExpoODOnvMzBbHmZU16GCYN54djTW4W1m6D_N_Q3IAS83ACAltx4SCY7D8FB7zGGxfTR36XwP4EbfcBsxm9whHyIawpot-EmC8PMx9POnFYGRzcTfgPQDr9m</recordid><startdate>20160515</startdate><enddate>20160515</enddate><creator>Qin, Mu</creator><creator>Liu, Xu</creator><creator>Jiang, Wei-Feng</creator><creator>Wu, Shao-Hui</creator><creator>Zhang, Xiao-Dong</creator><creator>Po, Sunny</creator><general>Elsevier Ireland Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TS</scope></search><sort><creationdate>20160515</creationdate><title>Vagal Response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation</title><author>Qin, Mu ; Liu, Xu ; Jiang, Wei-Feng ; Wu, Shao-Hui ; Zhang, Xiao-Dong ; Po, Sunny</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c516t-e034610aa5af5165c2b0b2f3979a574240464042ba8c72a94544f8de3cc7578f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Autonomic nervous system</topic><topic>Cardiovascular</topic><topic>Catheter Ablation - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Pulmonary vein isolation</topic><topic>Pulmonary Veins - innervation</topic><topic>Pulmonary Veins - physiopathology</topic><topic>Pulmonary Veins - surgery</topic><topic>Vagal response</topic><topic>Vagus Nerve - physiopathology</topic><topic>Vagus Nerve - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qin, Mu</creatorcontrib><creatorcontrib>Liu, Xu</creatorcontrib><creatorcontrib>Jiang, Wei-Feng</creatorcontrib><creatorcontrib>Wu, Shao-Hui</creatorcontrib><creatorcontrib>Zhang, Xiao-Dong</creatorcontrib><creatorcontrib>Po, Sunny</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Physical Education Index</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qin, Mu</au><au>Liu, Xu</au><au>Jiang, Wei-Feng</au><au>Wu, Shao-Hui</au><au>Zhang, Xiao-Dong</au><au>Po, Sunny</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vagal Response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2016-05-15</date><risdate>2016</risdate><volume>211</volume><spage>7</spage><epage>13</epage><pages>7-13</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract Background The role of autonomic innervation around the pulmonary vein (PV) antrum in the genesis of atrial fibrillation (AF) has been demonstrated but the characteristics of radiofrequency induced vagal response (VR) in the PV antrum and its clinical impact on pulmonary vein isolation (PVI) for paroxysmal AF need to be further elucidated. Method Of 995 consecutive patients with symptomatic paroxysmal AF undergoing PVI at a single center over a 2-year period, 516 met exclusion criteria and the remaining 479 patients, 156 positive VR (PVR) and 323 negative VR (NVR), underwent 12 months follow-up. The primary endpoint was freedom from AF or other sustained atrial tachycardia (AT), verified by monthly visits and electrocardiographic monitoring. The frequency-domain analysis was performed to evaluated the autonomic activity before and after procedure. Results VR was most commonly elicited during PVI at the LSPV roof (65.4%) and anterior RSPV (44.9%, with a > 5 s sinus pause in 37/70 [52.8%] cases). Compared with the NVR group, ablation was associated with reduced AF recurrence at 12 months in the PVR (hazard ratio: 0.53, 95% confidence interval: 0.22–0.89). Furthermore, the PVR group showed a significantly abbreviated AF cycle length at the left PV, and significantly lower HF and LF parameters with stable LF/HF ratio during follow-up. Conclusion Complete elimination of vagal response, most commonly elicited by radiofrequency application around the roof of LSPV and anterior RSPV, appeared associated with reduced 12-month recurrence of AF and with marked heart rate variability changes consistent with autonomic nervous withdrawal.</abstract><cop>Netherlands</cop><pub>Elsevier Ireland Ltd</pub><pmid>26963618</pmid><doi>10.1016/j.ijcard.2016.02.116</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Autonomic nervous system Cardiovascular Catheter Ablation - methods Female Follow-Up Studies Humans Male Middle Aged Prospective Studies Pulmonary vein isolation Pulmonary Veins - innervation Pulmonary Veins - physiopathology Pulmonary Veins - surgery Vagal response Vagus Nerve - physiopathology Vagus Nerve - surgery |
| title | Vagal Response during pulmonary vein isolation: Re-recognized its characteristics and implications in lone paroxysmal atrial fibrillation |
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