Correspondence

Abstract

We found the most interesting aspect of the article by Oh et al 1 Oh S. Zhang Y. Bibevski S. Marrouche N.F. Natale A. Mazgalev T.N. Vagal denervation and atrial fibrillation inducibility: epicardial fat pad ablation does not have long-term effects. Heart Rhythm. 2006; 3: 701-708 Abstract Full Text Full Text PDF PubMed Scopus (147) Google Scholar in the June 2006 issue of Heart Rhythm was the restoration of sinus node slowing and AV conduction block by right vagal stimulation 4 weeks after acute denervation of two clusters of ganglionated plexi (GP) on the heart. However, several major problems were evident throughout the article, starting with the article title, “Vagal denervation and atrial fibrillation inducibility: Epicardial fat pad ablation does not have long-term effects.” Previous studies have clearly shown that both parasympathetic and sympathetic elements reside in the GP on the heart 2 Lazzara R. Scherlag B.J. Robinson M.J. Samet P. Selective in situ parasympathetic control of the canine sinoatrial and atrioventricular nodes. Circ Res. 1973; 32: 393-401 Crossref PubMed Scopus (123) Google Scholar , 3 Ardell J.L. Structure and function of mammalian intrinsic cardiac neurons. in: Armour J.A. Ardell J.L. Neurocardiology. Oxford University Press, New York1994: 95-114 Google Scholar , 4 Singh S. Johnson P.I. Javed A. Gray T.S. Lonohyna V.A. Wurster R.D. Monomine and histamine synthesizing enzymes and neurotransmitters within neurons of adult human cardiac ganglia. Circulation. 1999; 99: 411-419 Crossref PubMed Scopus (75) Google Scholar ; therefore, the implication that only vagal denervation was induced is misleading. The authors must recognize that their epicardial fat pad ablation procedure was only partial because they left intact the GPs at the antra of the left superior and left inferior pulmonary veins, as well as other GP found along the posterior left atrium. Furthermore, use of right cervical vagal trunk stimulation may be inappropriate because the form of atrial fibrillation (AF) induced probably is due to macroreentry, which is short-lived (≤1 minute) and not due to sustained focal ectopy arising from pulmonary veins (PVs). 5 Po S.S. Scherlag B.J. Yamanashi W.S. Edwards J. Zhou J. Wu R. Geng N. Lazzara R. Jackman W.M. Experimental model for paroxysmal atrial fibrillation arising at the pulmonary vein–atrial junction. Heart Rhythm. 2006; 3: 201-208 Abstract Full Text Full Text PDF PubMed Scopus (187) Google Scholar The latter has been shown to occur by acetylcholine injection into fat pads containing GP adjacent to a right or left PV. The focal AF induced arises from the PV and sustains for periods longer that 20 minutes. To the Editors—ResponseHeart RhythmVol. 3Issue 10PreviewThe letter by Dr. Scherlag and associates commenting on our article published in Heart Rhythm1 provides a welcome opinion from one of the strong proponents of autonomic neural denervation as a potential novel therapeutic strategy for patients with atrial fibrillation (AF). Full-Text PDF