Shortening of Fibrillatory Cycle Length in the Pulmonary Vein During Vagal Excitation

© 2006 American College of Cardiology Foundation. Published by Elsevier Inc.ObjectivesThe goal of the present prospective study is to evaluate the impact of vagal excitation on ongoing atrial fibrillation (AF) during pulmonary vein (PV) isolation.BackgroundThe role of vagal tone in maintenance of AF is controversial in humans.MethodsTwenty-five patients (18 with paroxysmal AF, 7 with chronic AF) were selected by occurrence of vagal excitation during AF (atrioventricular [AV] block: R-R interval >3 s) produced by PV isolation. Fibrillatory cycle length (CL) in the targeted PV and coronary sinus (CS) were determined before, during, and after vagal excitation. The CL was available at PV ostium during vagal excitation in 11 patients.ResultsForty-eight episodes of vagal excitation were observed. During vagal excitation, CL abruptly decreased both in CS and PV (CS, 164 +/- 20 ms to 155 +/- 23 ms, p ConclusionsVagal excitation is associated with shortening of fibrillatory CL. This occurs earlier in PV with a sequential gradient to PV ostium and CS, suggesting that vagal excitation enhances a driving role of PV.Yoshihide Takahashi, Pierre Jaïs, Mélèze Hocini, Prashanthan Sanders, Martin Rotter, Thomas Rostock, Li-Fern Hsu, Frédéric Sacher, Jacques Clémenty and Michel Haïssaguerr