* Previously ineffective antiarrhythmics
The differences in complete success rates were not statistically significant.
The Australian researchers conclude that PVAI appears to be similarly effective in patients with vagal, adrenergic, and random paroxysmal AF. They observed no ablatable vagal reflexes during their procedures, but suggest that this may be due to the fact that they were done under general anesthesia, which may have modified the autonomic response. They also noted that afibbers who experienced episodes following their PVAI did not change their trigger classification (from vagal to adrenergic or random, or vice versa).
Rosso, R, et al. Vagal paroxysmal atrial fibrillation: prevalence and ablation outcome in patients without structural heart disease. Journal of Cardiovascular Electrophysiology, December 15, 2009 [Epub ahead of print]
Editor's comment: This recent Australian study is clearly of great interest to our afib community. It confirms the existence of three different varieties of paroxysmal AF – vagal, adrenergic and random. The percentages found for these three forms are very close to the percentages found in our 2008 Ablation/Maze Survey – for vagal 27% vs. 33%, for adrenergic 7% vs. 7%, and for random 66% vs. 60%. The study also confirms that resting/sleeping, heavy meals, and cold drinks are triggers for vagal afibbers, while emotional and physical stress are triggers for those with adrenergic afib. Of course, there are many more significant triggers than those reported here including caffeine, alcohol, food additive (MSG and aspartame), dehydration, and sleeping on the left side – to name a few. The overall success rate of 57% achieved by the Australian team is approaching the 65% average found for the 15 top-ranked institutions in our 2008 survey and is well above the 32% average for other than top-ranked institutions.