High-Frequency Stimulation of the Atria Increases Early Recurrence Following Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation

Study Questions:

What is the impact of high-frequency stimulation (HFS) on the short- and long-term outcomes after the ablation of persistent atrial fibrillation (AF)?


Thirty consecutive patients with persistent or long-standing persistent AF were randomly assigned to either receive HFS of the left atrium (n = 15) or not (n = 15) during their electrophysiological studies. Patients receiving HFS were examined to determine whether or not a vagal response was elicited by the HFS at sites where ganglionated plexi (GPs) were located before and after conventional pulmonary vein isolation without any ablation targeting the GPs. Patients not receiving the HFS underwent the ablation procedure alone. The rate of recurrence of AF within 3 months of the procedure (early recurrence [ER]) and the frequency of that occurring after that period (late recurrence) were compared between the patient groups.


The incidence of ER occurred more frequently in patients with HFS than in those without (80% vs. 40%; p = 0.015), whereas the occurrence of late recurrence was similar between the two groups (27% vs. 33%; p = 0.73). In the HFS group, the number of GPs decreased from 3.4 ± 1.1 to 1.5 ± 0.8 after the pulmonary vein isolation (p < 0.0001), and the decrease was smaller in the patients experiencing ER than in those without.


The authors concluded that HFS increases the incidence of ER in patients with persistent AF despite a partial GP modification resulting from the pulmonary vein isolation.


The study suggests that the HFS increased the incidence of ER following pulmonary vein isolation in patients with persistent AF, and the higher incidence of ER was at least uncontrolled by the partial GP modification resulting from the pulmonary vein isolation. Given that HFS of the atria is essential to carry out GP ablation, this result may imply that an incomplete GP ablation could result in the occurrence of ER in patients with persistent AF. To validate this hypothesis, additional studies are necessary to test whether a complete GP ablation is superior to a partial GP modification in preventing the recurrence of AF occurring early after the ablation procedure.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Incidence, Heart Atria, Recurrence, Pulmonary Veins, Atrial Fibrillation, Heart Rate, Catheter Ablation

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