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).