Catheter ablation of cardiac autonomic nerves for prevention of vagal atrial fibrillation

Abstract

Background - Vagal stimulation shortens the atrial effective refractory period (AERP) and maintains atrial fibrillation (AF). This study investigated whether the parasympathetic pathways that innervate the atria can be identified and ablated by use of transvenous catheter stimulation and radiofrequency current catheter ablation (RFCA) techniques. Methods and Results - In 11 dogs, AERPs were determined at 7 atrial sites during bilateral cervical vagal nerve stimulation (VNS) and electrical stimulation of the third fat pad (20 Hz) in the right pulmonary artery (RPA). VNS shortened the AERP at all sites (from 123±4 to 39±4 ms, P<0.001) and increased the covariance of AERP (COV-AERP) (from 9±3% to 27±13%, P<0.001). RPA stimulation shortened the AERP at all sites from 123±4 to 66±13 ms (P<0.001) and increased the COV-AERP from 9±3% to 30±12% (P<0.001). In 7 dogs, transvascular RFCA of the parasympathetic pathways along the RPA was performed, and in 3 dogs, additional RFCA of parasympathetic fibers along the inferior (n=2) or superior (n=1) vena cava was performed. RFCA blunted the AERP shortening at all sites during VNS (114±4 ms after RFCA), abolished the increase of COV-AERP during VNS (12±7% after RFCA), and led to an increase of the baseline AERP (123±4 ms before versus 127±3 ms after RFCA, P=0.002). Before RFCA, AF could be induced and maintained as long as VNS was continued, whereas after RFCA, AF was no longer inducible during VNS. Conclusions - Transvascular atrial parasympathetic nerve system modification by RFCA abolishes vagally mediated AF. This antifibrillatory procedure may provide a foundation for investigating the usefulness of neural ablation in chronic animal models of AF and eventually in patients with AF and high vagal tone.