Abstract 17688: Antifibrillatory Effects by Selective Ganglionated Plexi Ablation in Patients With Atrial Fibrillation
Background: Evidence in animal and clinical studies suggests that the autonomic nervous system modulation is an important mechanism for triggering and maintaining atrial fibrillation (AF). However, the role of isolated autonomic denervation in the effectiveness of ablation is not well established. The aim of this study was to assess the antifibrillatory effects in the pulmonary vein (PV) after ganglionated plexi (GP) ablation.
Methods: Thirty-two consecutive patients (age 59±10 years, 24 male, Paroximal AF: 14 patients) who underwent the selective GP ablation guided by high frequency stimulation (HFS) were enrolled in this study. The five major left atrial GP (superior left GP, Marshall tract GP, inferior left GP, anterior right GP, inferior right GP) were localized by delivering high frequency stimulation (HFS; 20 Hz, 20 V, 10 ms pulse width) to the atrial tissue where the GP was presumed to be located. Sites showing a parasympathetic response, which is defined as ≥50% increase in mean R-R interval during AF, was assigned as a GP site. Radiofrequency current is then applied to that site to eliminate the parasympathetic response. We ablated in the following order, 1. left side GP, 2. right side GP, 3. antrum PV isolation (APVI). Using a software (EP logics, Bard Electrophysiology), we measured cycle length (CL) during AF in each PV, LAA, CS, RA, before any ablation, after left side GP ablation, after right GP ablation, and after APVI. We investigated the termination of AF in relation with GP ablation.
Results: AF was sustained in 30 patients. AF terminated during GP ablation in 8 patients (27%), during APVI in 8 patients (27%). AFCL in LSPV (147±19ms) and LIPV 155±29) were prolonged after left side GP ablation (LSPVCL 174±29ms, LIPVCL 168±32ms, p<0.001). AFCL in RSPV (160±28ms) and RIPV (159±20ms) were significantly prolonged after right side GP ablation (RSPVCL 173±23ms, RIPVCL 172±23ms, p<0.01). CL in any other site did not change after ablation statistically.
Conclusions: Selective GP ablation alone showed antifibrillatory effects. Adjunctive antrum pulmonary vein isolation strengthened these effects. GP ablation significantly prolonged cycle length on this side of pulmonary veins, and induced to terminate atrial fibrillation.
- © 2010 by American Heart Association, Inc.