Abstract 2226: Autonomic Ganglionated Plexi Stimulation Induces Fractionated Atrial Potentials in Contralateral Pulmonary Veins in Patients With Atrial Fibrillation
Recent studies suggest that autonomic ganglionated plexi (GP) adjacent to pulmonary veins (PV) play an important role in initiation and maintenance of atrial fibrillation (AF). High frequency stimulation (HFS) of GP produces a vagal response (AV block) and fractionated atrial potentials (FAP) in the adjacent PV. The purpose of this study was to test for communication between GPs by searching for FAP in PVs remote from the stimulated GP.
Methods: In 18 pts (11 paroxysmal, 7 persistent) undergoing AF ablation (GP ablation and PV antrum isolation), the 4 left atrial GP were localized at sites where HFS (20 Hz, ≤ 12 V, pulse width ≤ 10ms) produced a vagal response (> 50% increase in mean R-R during AF). Electrograms were recorded from 1–3 PVs (Lasso), other atrial sites and CS during HFS. A positive response in a remote PV was defined as an increase in fractionation immediately after GP stimulation and greater fractionation than in the CS (Fig⇓).
Results: Anterior Right GP and Inferior Right GP stimulation induced a positive fractionated response in a left PV in 9/14 pts and 10/16 pts tested, respectively. Superior Left GP and Inferior Left GP stimulation induced a positive fractionated response in a right PV in 9/12 pts and 5/14 pts tested, respectively. The FAP response was less prominent at sites remote from the GP/PV areas (CS in Fig⇓).
Conclusions: HFS of a right or left GP induces FAP at contralateral PV/GP areas indicating GP interconnections.