Ablation of Epicardial Ganglionated Plexi Increases Atrial Vulnerability to Arrhythmias in Dogs

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.

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Vagal denervation and reinnervation after ablation of ganglionated plexi

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2009.04.056 ◽

2010 ◽

Vol 139 (2) ◽

pp. 444-452 ◽

Cited By ~ 58

Author(s):

Shun-ichiro Sakamoto ◽

Richard B. Schuessler ◽

Anson M. Lee ◽

Abdulhameed Aziz ◽

Shelly C. Lall ◽

...

Keyword(s):

Ganglionated Plexi

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Investigation of Atrial Vulnerability by Analysis of the Sinus Node EG From Atrial Fibrillation Models Using a Phase Synchronization Method

IEEE Transactions on Biomedical Engineering ◽

10.1109/tbme.2012.2208751 ◽

2012 ◽

Vol 59 (9) ◽

pp. 2668-2676 ◽

Cited By ~ 5

Author(s):

Ying Chen ◽

Zhong Wu ◽

Cuiwei Yang ◽

Jun Shao ◽

K. K. L. Wong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Phase Synchronization ◽

Sinus Node ◽

Synchronization Method ◽

Atrial Vulnerability

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The outcome of ablation for non-paroxysmal atrial fibrillation targeting spatiotemporal electrogram dispersion compared with ganglionated plexi ablation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0617 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Sakata ◽

T Tanaka ◽

S Yamashita ◽

K Yamashiro

Keyword(s):

Atrial Fibrillation ◽

Study Groups ◽

Atrial Arrhythmia ◽

Single Procedure ◽

Ganglionated Plexi ◽

Kaplan Meier ◽

Significant Difference ◽

Left And Right ◽

Fibrillatory Conduction ◽

And Control

Abstract Background Although catheter ablation targeting ganglionated plexi (GP) playing an important role in formation of triggers and substrates of atrial fibrillation (AF) has been reported as one of the effective ablation strategies in non-paroxysmal AF (non-PAF) patients, its effectiveness varies among the study groups. More recently, ablation targeting spatiotemporal electrogram dispersion (STED) areas, assumed to contain AF drivers in forms of rotational activation is proposed. However, the optimal ablation strategy for non-PAF is still controversial since the exact mechanisms of non-PAF are not well understood. Purpose To investigate the effectiveness of GP ablation for autonomic modification and STED ablation for modulation of AF drivers. Methods Consecutive 149 non-PAF patients who underwent STED ablation in our center were enrolled. We detected STED areas within the whole left and right atrium during AF using PentaRay®, and ablated them. If AF was terminated during STED ablation, we finished the procedure without burning the remaining STED areas. If not, electrical cardioversion was applied. The outcome was compared with that in consecutive 156 non-PAF patients undergoing GP ablation previously in our center. Results (1) The clinical characteristics were comparable between two groups (see Table). (2) A Kaplan-Meier curve showed that there was no significant difference between the freedom rates from non-PAF/non-paroxysmal atrial tachycardia (non-PAT) after single procedure in STED group and GP group (Figure, left). (3) However, the freedom rates from non-PAT in STED group was significantly lower than that GP group (Figure, right). Conclusions The recurrence type of atrial arrhythmia after ablation was remarkably different between ablation of STED and GP. STED ablation might eliminate fibrillatory conduction and control AF driver in patients with non-PAF. Freedom from atrial arrhythmia Funding Acknowledgement Type of funding source: None

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Effect of Low-Level Electrical Stimulation of the Arotic Root Ventricular Ganglionated Plexi on Electrical and Structural Remodling in Dogs with Heart Failure

Cardiology Open Access ◽

10.33140/coa.01.01.06 ◽

2016 ◽

Vol 1 (1) ◽

Keyword(s):

Heart Failure ◽

Nervous System ◽

Electrical Stimulation ◽

Autonomic Nervous System ◽

Aortic Root ◽

General Argument ◽

Low Level ◽

Ganglionated Plexi ◽

Atrial Enlargement ◽

Stimulation Of

Low-level electrical stimulation (LL-ES) of aortic root ventricular ganglionated plexi (GP) was proved to be antiarrhythmic in the initiation of AF mediated by autonomic nervous system. However,it is still uncertain whether LL-ES of the ventricular GP can reverse the structural remodeling of myocardial fibrosis and atrial enlargement following heart failure by attenuating the sympathetic tone. Therefore,this review will give an general argument on this topic.

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