Inappropriate Use of Atrioventricular Nodal Vagal Stimulation in Atrial Fibrillation
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To the Editor:
Zhuang et al1 showed well that slowing the ventricular rate by atrioventricular nodal vagal stimulation (AVN-VS) improved hemodynamics during atrial fibrillation (AF). This gave better hemodynamic responses than slowing the ventricular rate by atrioventricular nodal ablation with right ventricular pacing, which caused adverse effects that the authors cited. The authors then wrongly concluded, “…we believe that this novel strategy (AVN-VS) might be applicable in some patients, eg, postoperative patients with AF.”
However, atrial fibrillation after surgical operations, especially cardiac operations, is peculiar because it is self-limiting. This arrhythmia commonly starts on the second or third postoperative day, and it reverts to regular sinus rhythm in a few days if the fast ventricular rate is slowed. The ventricular rate can be slowed promptly …