Slow pathway ablation decreases vulnerability to pacing-induced atrial fibrillation: Possible role of vagal denervation

Mehdi Razavi, Jie Cheng, Abdi Rasekh, Donghui Yang, Scott Delapasse, Tomohiko Ai, Thomas Meade, Alan Donsky, Mary J. Goodman, Ali Massumi

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Studies indicate that success of radiofrequency (RF) ablation of atrial fibrillation (AF) may be in part due to vagal denervation. RFA of supraventricular tachycardia (SVT) has been associated with vagal denervation. The effects of slow pathway (SP) ablation on AF inducibility have not been studied. Objective: To test the hypothesis that SP ablation renders AF less inducible. Methods: Consecutive patients referred for SVT were studied. After atrioventricular nodal reentrant tachycardia (AVNRT) was confirmed they underwent induction of AF. After SP ablation AF induction was reattempted. Vulnerability to AF was reassessed. Results: Twenty-four patients were enrolled; eight were not inducible for AF in the preablative state. Mean CL of the AVNRT was 340 ± 16 ms. The average RF ablation time was 131 ± 42 seconds. Presence of junctional rhythm was required. Of the 16 with inducible AF two patients had AF induced during routine invasive electrophysiology study. None of these had inducible AF after SP ablation. Fourteen of 16 patients required specific AF induction. Ten of these were noninducible after SP ablation; two were inducible after SP ablation but with a more aggressive pacing protocol (P <0.03 compared to preablation) and two had no change in AF vulnerability. Seven of the eight noninducible patients remained noninducible for AF post SP ablation. In the 12 patients who were inducible prior but noninducible after ablation the mean atrial effective refractory period (AERP) increased for both BCL at 400 and 600 ms (400/216 ± 8 ms preablation vs 400/248 ± 12 ms postablation, P <0.03; 600/228 ± 8 ms preablation vs 600/259 ± 6 ms postablation, P <0.04). There were no significant changes in AERP of patients who remained inducible or who were noninducible before ablation. The average ablation time for patients who became noninducible after ablation was significantly higher than those who had no change in inducibility or remained inducible but at a more aggressive pacing threshold (157 ± 24 seconds vs 35 ± 5 seconds; P <0.005). Conclusion: SP ablation acutely decreases vulnerability to pacing-induced AF in patients with AVNRT. This may reflect the effect of ablation on atrial vagal tone.

Original languageEnglish (US)
Pages (from-to)1234-1239
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume29
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

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Denervation
Atrial Fibrillation
Atrioventricular Nodal Reentry Tachycardia
Supraventricular Tachycardia
Electrophysiology

Keywords

  • Catheter ablation
  • Electrophysiology
  • Fibrillation
  • Tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Slow pathway ablation decreases vulnerability to pacing-induced atrial fibrillation : Possible role of vagal denervation. / Razavi, Mehdi; Cheng, Jie; Rasekh, Abdi; Yang, Donghui; Delapasse, Scott; Ai, Tomohiko; Meade, Thomas; Donsky, Alan; Goodman, Mary J.; Massumi, Ali.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 29, No. 11, 11.2006, p. 1234-1239.

Research output: Contribution to journalArticle

Razavi, Mehdi ; Cheng, Jie ; Rasekh, Abdi ; Yang, Donghui ; Delapasse, Scott ; Ai, Tomohiko ; Meade, Thomas ; Donsky, Alan ; Goodman, Mary J. ; Massumi, Ali. / Slow pathway ablation decreases vulnerability to pacing-induced atrial fibrillation : Possible role of vagal denervation. In: PACE - Pacing and Clinical Electrophysiology. 2006 ; Vol. 29, No. 11. pp. 1234-1239.
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abstract = "Background: Studies indicate that success of radiofrequency (RF) ablation of atrial fibrillation (AF) may be in part due to vagal denervation. RFA of supraventricular tachycardia (SVT) has been associated with vagal denervation. The effects of slow pathway (SP) ablation on AF inducibility have not been studied. Objective: To test the hypothesis that SP ablation renders AF less inducible. Methods: Consecutive patients referred for SVT were studied. After atrioventricular nodal reentrant tachycardia (AVNRT) was confirmed they underwent induction of AF. After SP ablation AF induction was reattempted. Vulnerability to AF was reassessed. Results: Twenty-four patients were enrolled; eight were not inducible for AF in the preablative state. Mean CL of the AVNRT was 340 ± 16 ms. The average RF ablation time was 131 ± 42 seconds. Presence of junctional rhythm was required. Of the 16 with inducible AF two patients had AF induced during routine invasive electrophysiology study. None of these had inducible AF after SP ablation. Fourteen of 16 patients required specific AF induction. Ten of these were noninducible after SP ablation; two were inducible after SP ablation but with a more aggressive pacing protocol (P <0.03 compared to preablation) and two had no change in AF vulnerability. Seven of the eight noninducible patients remained noninducible for AF post SP ablation. In the 12 patients who were inducible prior but noninducible after ablation the mean atrial effective refractory period (AERP) increased for both BCL at 400 and 600 ms (400/216 ± 8 ms preablation vs 400/248 ± 12 ms postablation, P <0.03; 600/228 ± 8 ms preablation vs 600/259 ± 6 ms postablation, P <0.04). There were no significant changes in AERP of patients who remained inducible or who were noninducible before ablation. The average ablation time for patients who became noninducible after ablation was significantly higher than those who had no change in inducibility or remained inducible but at a more aggressive pacing threshold (157 ± 24 seconds vs 35 ± 5 seconds; P <0.005). Conclusion: SP ablation acutely decreases vulnerability to pacing-induced AF in patients with AVNRT. This may reflect the effect of ablation on atrial vagal tone.",
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T1 - Slow pathway ablation decreases vulnerability to pacing-induced atrial fibrillation

T2 - Possible role of vagal denervation

AU - Razavi, Mehdi

AU - Cheng, Jie

AU - Rasekh, Abdi

AU - Yang, Donghui

AU - Delapasse, Scott

AU - Ai, Tomohiko

AU - Meade, Thomas

AU - Donsky, Alan

AU - Goodman, Mary J.

AU - Massumi, Ali

PY - 2006/11

Y1 - 2006/11

N2 - Background: Studies indicate that success of radiofrequency (RF) ablation of atrial fibrillation (AF) may be in part due to vagal denervation. RFA of supraventricular tachycardia (SVT) has been associated with vagal denervation. The effects of slow pathway (SP) ablation on AF inducibility have not been studied. Objective: To test the hypothesis that SP ablation renders AF less inducible. Methods: Consecutive patients referred for SVT were studied. After atrioventricular nodal reentrant tachycardia (AVNRT) was confirmed they underwent induction of AF. After SP ablation AF induction was reattempted. Vulnerability to AF was reassessed. Results: Twenty-four patients were enrolled; eight were not inducible for AF in the preablative state. Mean CL of the AVNRT was 340 ± 16 ms. The average RF ablation time was 131 ± 42 seconds. Presence of junctional rhythm was required. Of the 16 with inducible AF two patients had AF induced during routine invasive electrophysiology study. None of these had inducible AF after SP ablation. Fourteen of 16 patients required specific AF induction. Ten of these were noninducible after SP ablation; two were inducible after SP ablation but with a more aggressive pacing protocol (P <0.03 compared to preablation) and two had no change in AF vulnerability. Seven of the eight noninducible patients remained noninducible for AF post SP ablation. In the 12 patients who were inducible prior but noninducible after ablation the mean atrial effective refractory period (AERP) increased for both BCL at 400 and 600 ms (400/216 ± 8 ms preablation vs 400/248 ± 12 ms postablation, P <0.03; 600/228 ± 8 ms preablation vs 600/259 ± 6 ms postablation, P <0.04). There were no significant changes in AERP of patients who remained inducible or who were noninducible before ablation. The average ablation time for patients who became noninducible after ablation was significantly higher than those who had no change in inducibility or remained inducible but at a more aggressive pacing threshold (157 ± 24 seconds vs 35 ± 5 seconds; P <0.005). Conclusion: SP ablation acutely decreases vulnerability to pacing-induced AF in patients with AVNRT. This may reflect the effect of ablation on atrial vagal tone.

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KW - Catheter ablation

KW - Electrophysiology

KW - Fibrillation

KW - Tachyarrhythmias

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