What have other studies shown?
Several groups have previously evaluated the clinical impact of ICANS
modulation on AF, both endocardially with catheter ablation as well as
epicardially with surgical ablation (Table 1). Although some studies
have shown benefit of adding ICANS modulation to PV isolation (6-8,10),
others have not (9,11). Certainly, no study has shown ICANS modulation
alone to be superior to PVI. Furthermore, it is important to note that
ICANS modulation can be associated with procedural risks, either in
terms of procedural complications (11) or greater radiation exposure
(10). Indeed, an apparently paradoxical interaction between ICANS and AF
has been reported too; in a group of dogs in whom the major GPs and
ligament of Marshall were ablated, significant prolongation of the
effective refractory period and decrease in AF inducibility was seen
acutely, and yet eight weeks later, the effective refractory period was
significantly shorter and AF inducibility was significantly greater than
in a sham control group (12).