Pulmonary Vein Isolation and QT prolongation in Paroxysmal Atrial fibrillation : What Have We Learned?

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and is a significant public health burden. 1,2 Many mutations in ion-channel and non ion-channel structural genes are linked to AF especially in patients with family history and no risk factors. 3 The pulmonary vein muscle sleeves are the main trigger for AF. 4 Many studies showed that pulmonary vein isolation (PVI) via catheter ablation is superior to medical therapy in decreasing all-cause mortality, hospitalizations and recurrence [5][6][7] . Though it is still controversial, vagal denervation and targeting the major atrial ganglionated plexi (GP) have been reported by Pappone et al. to improve the outcome after PVI. 8 GP ablation has been associated with QT prolongation and ventricular arrhythmias 9 . PVI affects the atrial GP, modifies the intrinsic cardiac autonomic nervous system and could lead to QT prolongation and lethal ventricular arrhythmias such as torsade de pointe and ventricular tachycardia. 10