Pulmonary veins isolation in a patient with atrial fibrillation and pronounced vagal response: Is it enough?
2017
Introduction. Pulmonary vein isolation (PVI) by antral circumferential
ablation is the standard procedure for patients with symptomatic and
drug-refractory paroxysmal atrial fibrillation (AF). In some patients
addition of ganglionated plexi (GP) modification in anatomic locations to PVI
confers significantly better outcomes than PVI alone. Case report. We
reported a patient with paroxysmal, symptomatic AF and severe bradycardia a
month prior to ablation. The patient was treated with antiarrhythmic drugs
without success. Because of severe bradicardia the patient was implanted with
a temporary pace maker two days before PVI. During PVI the decision was made
to also do a modification of the left GP. Three months after the procedure
the patients was in stable sinus rhythm without any symptoms. Conclusion. In
selected patients with paroxysmal AF and pronounced vagal response PVI by
circumferential antral ablation combined with GP modification during single
ablation procedure can produce higher success rates than PVI or GP ablation
alone.
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