scholarly journals Impact of ganglionated plexi ablation on high-frequency stimulation-induced changes in atrial fibrillation cycle length in the pulmonary vein

2014 ◽  
Vol 30 (5) ◽  
pp. 356-361 ◽  
Author(s):  
Mitsuru Takami ◽  
Kohei Yamashiro ◽  
Yuichiro Sakamoto ◽  
Koyo Satoh ◽  
Takahiko Suzuki
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
High Frequency ◽  
Cycle Length ◽  
High Frequency Stimulation ◽  
Ganglionated Plexi ◽  
Frequency Stimulation ◽  
Induced Changes

scholarly journals Is Vagal Response During Left Atrial Ganglionated Plexi Stimulation a Normal Phenomenon?

2019 ◽  
Vol 12 (10) ◽  
Author(s):  
Kazuki Iso ◽  
Yasuo Okumura ◽  
Ichiro Watanabe ◽  
Koichi Nagashima ◽  
Keiko Takahashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulse Duration ◽  
High Frequency ◽  
Left Atrial ◽  
Accessory Pathway ◽  
High Frequency Stimulation ◽  
Ganglionated Plexi ◽  
Multivariate Adjustment ◽  
Frequency Stimulation ◽  
The Mean

Background: Ganglionated plexi (GPs) play an important role in both the initiation and maintenance of atrial fibrillation (AF). GPs can be located by using continuous high-frequency stimulation (HFS) to elicit a vagal response, but whether the vagal response phenomenon is common to patients without AF is unknown. Methods: HFS of the left atrial GPs was performed in 42 patients (aged 58.0±10.2 years) undergoing ablation for AF and 21 patients (aged 53.2±12.8 years) undergoing ablation for a left-sided accessory pathway. The HFS (20 Hz, 25 mA, 10-ms pulse duration) was applied for 5 seconds at 3 sites within the presumed anatomic area of each of the 5 major left atrial GPs (for a total of 15 sites per patient). We defined vagal response to HFS as prolongation of the R-R interval by >50% in comparison to the mean pre-HFS R-R interval averaged over 10 beats and active-GP areas as areas in which a vagal response was elicited. Results: Overall, more active-GP areas were found in the AF group patients than in the non-AF group patients, and at all 5 major GPs, the maximum R-R interval during HFS was significantly prolonged in the AF patients. After multivariate adjustment, association was established between the total number of vagal response sites and the presence of AF. Conclusions: The significant increase in vagal responses elicited in patients with AF compared with responses in non-AF patients suggests that vagal responses to HFS reflect abnormally increased GP activity specific to AF substrates.

Abstract 18957: Modulation of Ganglionated Plexi as an Addition to Pv Isolation in Persistent Atrial Fibrillation Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sabine Ernst ◽  
Richard Underwood ◽  
Sonya Babu-Narayan ◽  
Simona Ben-Haim
Keyword(s):  
Atrial Fibrillation ◽  
3D Imaging ◽  
Imaging Study ◽  
Persistent Atrial Fibrillation ◽  
High Frequency Stimulation ◽  
Af Ablation ◽  
Road Map ◽  
Ganglionated Plexi ◽  
Individual Variations ◽  
Frequency Stimulation

Introduction: Catheter ablation of ganglionated plexi (GP) as an add on to pulmonary vein (PV) isolation has been reported to significantly improve outcome of atrial fibrillation (AF) ablation. In order to facilitate localization of these GPs, a novel imaging study is proposed that investigates the uptake of iodine-123 metaiodobenzylguanidine (mIBG, an analogon for norepinephrine) on the atrial level. This information is combined with 3D surface reconstruction from contrast computed tomography (cCT) or cardiac magnetic resonance (CMR). Methods: A total of 7 patients (5 male, mean age 64.3 yrs) with AF underwent mIBG nuclear studies using a dedicated solid state cardiac camera (D-SPECT, Spectrum Dynamics). Four patient had 4 persistent AF (3 prev. abl.) with less than 1 year of sustained AF, whereas 3 patient were in longstanding persistent AF (all prev. abl). The acquired data was merged with the 3D imaging and subsequently imported into the 3D electroanatomical mapping system (CARTO, Biosense Webster). During invasive AF ablations these sites were mapped to perform high frequency stimulation (HFS) to confirm GP locations. Results: In all pts, both the mIBG and CT scans were performed without any complications. Locations of high mIBG uptake corresponded to anatomical GP sites (LA & RA) in the majority of patients, but individual variations were observed. PV isolation was added in all but 1 pt (who had previous ablation) plus CFAE ablation if necessary. Follow-up of in median of 10.4 months demonstrated SR in all persistent AF patients (1 redo for atrial reentry). In patients with longstanding persistent AF: 2 pts are in SR (both AF at 1 week and 1 pt in AT at 6 weeks), while 1 pt remained in AF. Conclusion: The combination of mIBG and 3D imaging provides a novel type of “road map” for localizing GPs during AF ablation. As an add-on to PV (re-) isolation, this strategy was found to be beneficial for patients with persistent and longstanding persistent AF. Interestingly, pts with longstanding persistent AF (and multiple previous ablations) all recurred early in F/U but showed reversal to AT and finally SR at later stages. Further studies in larger patient cohorts need to confirm these initial observations.

Abstract 19466: Preliminary Experience Using Multiplexed Imaging of the Sympathetic Autonomic Nervous System - Impact on Outcome of Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sabine Ernst ◽  
Francesca Menichetti ◽  
Rafael Baavour ◽  
Nathaniel Roth ◽  
Jamshed Bomanji ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
High Frequency ◽  
De Novo ◽  
Imaging Study ◽  
High Frequency Stimulation ◽  
High Uptake ◽  
Af Ablation ◽  
Uptake Sites ◽  
Frequency Stimulation

Introduction: Catheter ablation of ganglionated plexi (GP) as an add on to pulmonary vein (PV) isolation has been reported to significantly improve outcome of atrial fibrillation (AF) ablation. In order to facilitate localization of these GPs, a novel imaging study is proposed, assessing the uptake of iodine-123 metaiodobenzylguanidine (mIBG, an analog of norepinephrine)in combination with 3D surface reconstruction from contrast computed tomography (cCT) or cardiac magnetic resonance (CMR). Methods: A total of 8 patients (5 male, median age 58 yrs) underwent mIBG SPECT using a dedicated cardiac camera (D-SPECT, SUMO, Spectrum Dynamics). This data was merged with 3D CMR or cCT and finally imported into CARTO (Biosense Webster). Using the individual mediastinum uptake as a normalizing factor, high uptake sites in the epicardial fat pads around the left atrium (LA) were identified. Five patients had paroxysmal AF whilst 3 present in persistent (n=2) or longstanding persistent (n=1) AF. Only 3 patients were treated de-novo, with the remaining failing in median 2 previous ablation procedures. Invasively, high uptake sites were mapped using high frequency stimulation (HFS) to confirm GP locations, which were subsequently ablated. PV (re) isolation and CFAE ablation was performed as needed. Results: Both the mIBG and CT or CMR scans were performed without complications. Focal mIBG uptake sites corresponded to anatomical GP sites, but individual variations of additional GPs were observed. Using HFS stimulation, GP sites were confirmed, but exact localization was highly depending on accurate image registration. Median follow-up of 9.2 months with all PAF and persistent AF patients in SR (1 AT redo), while the long-standing AF relapsed. Conclusion: The combination of mIBG SPECT and 3D anatomical imaging (SUMO protocol) provides a novel type of “road map” for localizing GPs during AF ablation. GPs were variable in number and location and were invasively confirmed using high frequency stimulation. Addition of GP ablation to standard AF ablation strategies seems beneficial in patients with paroxysmal or persistent AF. Further studies in larger patient cohorts are needed to confirm these initial observations.

FREQUENCY ESTIMATION FOR ATRIAL FIBRILLATION FROM HUMAN STUDIES

2016 ◽  
Vol 78 (7-4) ◽  
Author(s):  
Anita Ahmad
Keyword(s):  
Atrial Fibrillation ◽  
European Union ◽  
High Frequency ◽  
Frequency Estimation ◽  
Dominant Frequency ◽  
High Frequency Stimulation ◽  
The European Union ◽  
Mortality And Morbidity ◽  
Spectral Techniques ◽  
Frequency Stimulation

Atrial Fibrillation (AF) is the most common disorder of the heart rhythms. There are about 2.3 million people in United States and 4.5 million people in the European Union with AF [1]. It is also one of the factors that may contribute to mortality and morbidity. Researchers who apply spectral techniques show that certain areas of the atria can have higher activation frequencies than other areas. Frequency analysis is used to measure changes in Dominant Frequency (DF). We access the electrical propagation inside the atria by spectrogram plotting and examining the effect of high frequency stimulation on human.

scholarly journals Catheter pulmonary vein isolation with drug testing of dormant conduction and detection of non-pulmonary vein triggers and high frequency stimulation of left atrial ganglionated plexi in patients with paroxysmal atrial fibrillation

2018 ◽  
Vol 22 (3) ◽  
pp. 39
Author(s):  
Yu. S. Krivosheev ◽  
D. I. Bashta ◽  
A. A. Simonyan ◽  
N. A. Tihonova ◽  
K. V. Modnikov ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Frequency ◽  
Drug Testing ◽  
High Frequency Stimulation ◽  
Group Iii ◽  
Group I ◽  
Frequency Stimulation ◽  
Group Ii

<p><strong>Background.</strong> Catheter pulmonary vein isolation (PVI) is the main interventional procedure for treatment of atrial fibrillation (AF). Recurrences of arrhythmia paroxysms in the postoperative period are mainly determined by reconnection of conduction from the pulmonary veins. However, non-pulmonary vein triggers and a positive vagal response of ganglionated plexi (GP) to high frequency stimulation after PVI confirmed by drug testing may affect the long-term efficacy of catheter AF ablation.<br /><strong>Aim.</strong> To evaluate the efficacy of PVI isolation after drug testing and a negative response to high-frequency stimulation and a positive response to high-frequency stimulation but without subsequent ablation in patients with paroxysmal AF, as well as the efficacy of PVI confirmed by drug testing in patients having nonpulmonary vein triggers.<br /><strong>Methods</strong>. The present analysis is a part of the randomized study on the comparison of PVI confirmed by drug testing with the absence of non-pulmonary vein triggers and a positive response of GP to high-frequency stimulation with and without GP ablation. PVI was performed in 311 patients. Ninety-six patients were<br />excluded because they required additional GP ablation. Two hundred and fourteen patients were divided into three groups: PVI with a positive GP response (posGP) to high-frequency stimulation without GP ablation (group I, n = 97), PVI with a negative GP response (negGP) to high-frequency stimulation (group II, n = 79) and PVI with non-pulmonary vein triggers (group III, n = 38). The primary endpoint of the study was the freedom from any atrial tachyarrhythmias<br />after 12 months of follow-up confirmed by 24-hour Holter monitoring. The secondary endpoints included the frequency of detecting dormant pulmonary vein conduction, non-pulmonary vein triggers, negative GP response to high-frequency stimulation after catheter PVI. The patients were followed 3, 6, 9, 12 months after the ablation procedure.<br /><strong>Results</strong>. At the end of the follow-up 57 (72.2%) patients in the PVI + negGP group (group II), 58 (59.8%) patients in the PVI + posGP group (group I) and 20 (52.6%) patients in the PVI + NPT (group III) were free from any atrial tachyarrhythmia (р=0.07; log-rank test). A statistical significance in the efficacy was observed when group II was compared with group III (72.2% and 52.6%, р = 0.028, log-rank test). In the course of primary ablation following PVI, when performing drug testing, dormant atriovenous conduction sites were observed in 105 (33.8%) patients, while non-pulmonary vein triggers (n = 79) were recorded in 38 (12.2%) patients. The frequency of negative GP responses to high-frequency stimulation after PVI accounted for 28.3%.<br /><strong>Conclusion</strong>. Pulmonary vein isolation confirmed by drug testing, without a response of GP to high-frequency stimulation tends to provide higher efficacy in maintaining the sinus rhythm as compared with PVI and a positive GP response to high-frequency stimulation, but without a statistical significance, whereas nonpulmonary vein triggers after PVI are associated with lower efficacy in the long-term follow-up.</p><p>Received 31 July 2018. Revised 8 August 2018. Accepted 14 August 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest</strong>: Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: Yu.S. Krivosheev, D.I. Bashta, V.N. Kolesnikov<br />Data collection and analysis: Yu.S. Krivosheev, D.I. Bashta, N.A. Tihonova<br />Drafting the article: Yu.S. Krivosheev, A.A. Simonyan<br />Critical revision of the article: V.N. Kolesnikov, K.V. Modnikov, T.A. Myznikova<br />Final approval of the version to be published: Yu.S. Krivosheev, D.I. Bashta, A.A. Simonyan, N.A. Tihonova, K.V. Modnikov, T.A. Myznikova, Z.A. Mishodzheva,<br />V.N. Kolesnikov</p>

scholarly journals Ganglionated plexi ablation with pulmonary vein isolation after testing dormant pulmonary vein conduction and excluding non-pulmonary triggers in patients with paroxysmal atrial fibrillation

2018 ◽  
Vol 22 (3) ◽  
pp. 25
Author(s):  
Yu. S. Krivosheev ◽  
D. I. Bashta ◽  
A. A. Simonyan ◽  
S. Yu. Krasilnikova ◽  
L. I. Vilenskiy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Conflict Of Interest ◽  
Paroxysmal Atrial Fibrillation ◽  
High Frequency Stimulation ◽  
Ganglionated Plexi ◽  
Group I ◽  
Dormant Conduction

<p><strong>Background.</strong> Pulmonary vein isolation (PVI) is the gold standard of interventional atrial fibrillation (AF) treatment, however, it doesn't provide a stable clinical effect and durable PVI in the long-term follow-up due to reconnections within the ablation line. To increase the efficacy of surgery, modulation of the autonomic nervous system can be combined with pulmonary vein isolation.<br /><strong>Aim.</strong> The study was focused on the evaluation of efficacy of ganglionated plexi (GP) ablation combined with PVI, and intraoperative drug testing of dormant pulmonary vein conduction and exclusion of non-pulmonary vein triggers in patients with paroxysmal atrial fibrillation.<br /><strong>Methods.</strong> There hundred sixty-seven patients with paroxysmal AF scheduled for catheter ablation were initially screened. PVI was performed in all patients. After testing with adenosine triphosphate and isoprenaline for dormant conduction following PVI and exclusion of non-pulmonary vein triggers, 194 patients with a positive response to high-frequency stimulation in the main GP sites of the left atrium were randomized in two groups: PVI (group I, n = 97), PVI with anatomical GP ablation (group II, n = 97). To perform continuous ECG monitoring, 53 patients received implantable cardiac monitors. The primary endpoint of the study was the freedom from any atrial tachyarrhythmias after 12 months of follow- up as recorded by 24-hour Holter monitoring. The secondary endpoints included AF burden based on implantable cardiac monitors data and predictors of AF recurrences. The patients were followed 3, 6, 9, 12 months after the ablation procedure.<br /><strong>Results.</strong> The mean follow-up was 12.5±2.2 months. By the end of the follow-up, 79 (81.4%) patients in the PVI with GP ablation group and 58 (59.8%) patients in the PVI only group were free from any atrial tachyarrhythmia (р=0.0012; log-rank test, HR 0.41, 95% CI [0.23–0.72], р=0.002; Cox regression). Implantable cardiac monitors data revealed that AF burden was significantly lower in the PVI with GP group as compared with the PVI only group (14.8±1.7% and 5.4±0.7%,<br />р&lt;0.001). According to the multivariable regression analysis, the independent predictors of AF recurrences were AF duration and presence of diabetes mellitus, while GP ablation reduced the risk of AF recurrence by 61%.<br /><strong>Conclusion.</strong> Ganglionated plexi ablation combined with pulmonary vein isolation confirmed by testing dormant conduction and excluding non-pulmonary triggers provides higher efficacy in maintaining the sinus rhythm as compared with PVI only in patients with paroxysmal atrial fibrillation.</p><p>Received 17 July 2018. Revised 7 August 2018. Accepted 10 August 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: Yu.S. Krivosheev, L.I. Vilenskiy, V.N. Kolesnikov<br />Data collection and analysis: Yu.S Krivosheev, D.I. Bashta, A.A. Simonyan<br />Drafting the article: Yu.S. Krivosheev, A.A. Simonyan, D.I. Bashta, S.Yu. Krasilnikova<br />Critical revision of the article: V.N. Kolesnikov<br />Final approval of the version to be published: Yu.S. Krivosheev, D.I. Bashta, A.A. Simonyan, S.Yu. Krasilnikova, L.I. Vilenskiy, T.A. Myznikova, Z.A. Mishodzheva, V.N. Kolesnikov</p>

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