Abstract 10712: Effective Modification to Complex Fractionated Atrial Electrogram by Ablation for Ganglionated Plexus in Patients With Atrial Fibrillation
It is reported that ganglionated plexus (GP) induce pulmonary vein (PV) firing, and shorten atrial refractory period, on the other hand, complex fractionated atrial electrogram (CFAE) are slow conduction zone and pivot point during atrial fibrillation (AF). Therefore, GP and CFAE are considered to play a critical role to sustain AF. But the relation between GP and CFAE is not known well.
Methods : Consecutive 77 patients with AF (49 paroxysmal, 13 persistent, 15 longstanding) who underwent catheter ablation were enrolled. CFAE map was obtained before (pre CFAE) and after (post CFAE) GP ablation in left atrium (LA) by using a real-time EnSite electroanatomic mapping system. PV isolation was done in all cases after post CFAE mapping. Deviding LA into 24 segments (Figure), we studied how GP ablation impacted on the CFAE in each segment, and examined the concordance rate of localization of GP and that of CFAE.
Results : Pre CFAE were identified in the area 1~6, 8~10, 13~15, 18, 19, and 22~24 more than 50% of all cases. Superior left GP was identified with a probability of 97.4%, and was ablated on average 5 points, and Marshall tract GP (79.2% ; 2 points), inferior left GP (80.5% ; 4 points), anterior right GP (93.5% ; 4 points), inferior right GP (76.6% ; 2 points) were also identified and ablated. Total CFAE area were decreased (pre CFAE area 56.6±39.0cm2, post CFAE area 27.2±22.9cm2, P<.0001) after ablating GP. CFAE area was significantly decreased, not only in the segments with GP ablation but also in the segments without GP ablation. Overlapped area with pre CFAE area and GP were the area 4 (roof-anterior area of left-superior PV ostium, P<0.005) and the area 23 (bottom-posterior area of LA, P<0.05).
Conclusions : CFAE is decreased effectively by GP ablation in all area in LA. CFAE and GP are overlapped in roof-anterior area of left-superior PV ostium and bottom-posterior area of LA, indicating that the two area may play a important role as the major substrate of AF.
- © 2012 by American Heart Association, Inc.