Ablation of right pulmonary veins and ganglionated plexi; entrance/exit block testing

ASVIDE ◽  
2016 ◽  
Vol 3 ◽  
pp. 306-306
Author(s):  
Dawn S. Hui ◽  
Richard Lee
Keyword(s):  
Pulmonary Veins ◽  
Ganglionated Plexi ◽  
Exit Block

scholarly journals Prevalence and significance of Exit Block During Arrhythmias Arising in Pulmonary Veins

2000 ◽  
Vol 11 (4) ◽  
pp. 379-386 ◽  
Author(s):  
HUNG-FAT TSE ◽  
CHU-PAK LAU ◽  
WILLIAM KOU ◽  
FRANK PELOSI ◽  
HAKAN ORAL ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Exit Block

Intraoperative CARTO Mapping for Atrial Fibrillation Ablation in Patients Undergoing Cardiac Surgery

2021 ◽  
Author(s):  
Sara Rita Vacirca
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Atrial Fibrillation Ablation ◽  
Surgical Ablation ◽  
Before And After ◽  
The Mean ◽  
Exit Block

Objective: Intraoperative CARTO Mapping for Atrial Fibrillation ablation in cardiac surgery. Background: Surgical ablation of Atrial Fibrillation is usually performed without mapping. The study aims to determine if intraoperative CARTO can be useful to guide the ablating procedure. Methods and Findings: Fourteen patients with symptomatic and drug-refractory concomitant AF were operated on in 2003 and 2004. CARTO mapping was performed before and after surgical bipolar radio-frequency ablation. Application of energy was repeated when residual electrical activity was detected at the pulmonary veins-atrial junction. Pacing wires were applied on right and left pulmonary veins distally to the ablation line to confirm the exit block. The mapping protocol was completed in 12 patients. Acute left atrium-pulmonary vein isolation was achieved after single or double energy application in 2/12 (16.6%) and 9/12 (75%) patients, respectively. The mean duration of the mapping and ablation procedure was 67 minutes. At discharge, PV isolation persisted in 10 patients: exit block was confirmed by the absence of pacing through the pulmonary veins electrodes. After a mean follows up of 181 months, no further recurrent AF events were registered in 9/12 (69.2%) patients. Conclusions: CARTO system is useful during open-heart surgery to guide the ablating strategy.

Utility of Exit Block for Identifying Electrical Isolation of the Pulmonary Veins

2002 ◽  
Vol 13 (10) ◽  
pp. 971-979 ◽  
Author(s):  
EDWARD P. GERSTENFELD ◽  
SANJAY DIXIT ◽  
DAVID CALLANS ◽  
ROBERT RHO ◽  
YADAVENDRA RAJAWAT ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Electrical Isolation ◽  
Exit Block

Autonomic Ganglionated Plexi: Characterization and Effect of Epicardial Microwave Ablation in a Canine Model of Vagally Induced Acute Atrial Fibrillation

2007 ◽  
Vol 2 (1) ◽  
pp. 7-13
Author(s):  
Husam H. Balkhy ◽  
John Hare ◽  
Haris J. Sih
Keyword(s):  
Atrial Fibrillation ◽  
High Frequency ◽  
Microwave Ablation ◽  
Vagal Stimulation ◽  
Pulmonary Veins ◽  
Canine Model ◽  
Av Block ◽  
Fat Pad ◽  
Ganglionated Plexi ◽  
Fat Pads

Objective Autonomic ganglionated plexi (GP) in fat pads near the pulmonary veins may contribute to initiation and maintenance atrial fibrillation (AF). We attempted to localize these plexi in a canine model, and evaluate the efficacy of microwave ablation in eliminating their vagal reflexes. Methods 8 Mongrel dogs (25–31 kg), underwent cervical vagal trunk stimulation to produce AV nodal block and sustained AF. Sternotomy was performed and the epicardial fat on the posterior left atrium and pulmonary veins was locally stimulated at high-frequency (20 Hz, 3–5 mA). Locations that produced a vagal response were identified and in 7 dogs ablated using the Flex 4 epicardial microwave ablation probe (Guidant Corp) at 65 watts/90 sec. One animal was a control and not ablated. Vagal responses were retested with local stimulation as well as stimulation of the cervical vagal trunks. The presence of AV block and duration of sustained AF was recorded. Results Baseline cervical vagal stimulation produced AV block and AF in all the animals. Local high-frequency stimulation (HFS) elicited vagal responses at the junction of the inferior vena cava and the middle pulmonary vein (IVC-MPV) in 8 animals, the base of the left pulmonary veins/ligament of Marshall (LoM) in 5 animals, and between the upper and lower right pulmonary veins (RPV) in 2 animals. Microwave ablation at the IVC-MPV eliminated the vagal response upon local fat pad HFS. Cervical vagal trunk stimulation yielded less AV block (n = 2) or no AV block (n = 5) after microwave ablation of the IVC-MPV alone (n = 4) or in conjunction with LoM area ablation (n = 3). The average duration of AF during cervical vagal stimulation decreased significantly from baseline (52.7 ± 27.0 sec) versus after fat pad ablation (13.8 ± 20.3 sec, p = 0.004). Conclusions In a canine model we found the primary epicardial autonomic ganglionated plexi to be at the junction of the IVC-MPV. Epicardial microwave ablation of this GP eliminated the vagal response during local fat pad stimulation; and attenuated or eliminated AV block and induction of sustained AF during cervical vagal trunk stimulation. Epicardial microwave ablation of the ganglionated plexi in epicardial fat pads is feasible and can eliminate vagal reflexes that maybe important in atrial fibrillation.

scholarly journals Vagal Reactions during Cryoballoon-Based Pulmonary Vein Isolation: A Clue for Autonomic Nervous System Modulation?

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Michaël Peyrol ◽  
Jérémie Barraud ◽  
Linda Koutbi ◽  
Baptiste Maille ◽  
Lory Trevisan ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Pulmonary Vein ◽  
Observational Studies ◽  
Pulmonary Veins ◽  
Cardiac Autonomic Nervous System ◽  
Autonomic Nervous ◽  
Ganglionated Plexi ◽  
Vast Network

Although paroxysmal atrial fibrillation (AF) is known to be initiated by rapid firing of pulmonary veins (PV) and non-PV triggers, the crucial role of cardiac autonomic nervous system (ANS) in the initiation and maintenance of AF has long been appreciated in both experimental and clinical studies. The cardiac intrinsic ANS is composed of ganglionated plexi (GPs), located close to the left atrium-pulmonary vein junctions and a vast network of interconnecting neurons. Ablation strategies aiming for complete PV isolation (PVI) remain the cornerstone of AF ablation procedures. However, several observational studies and few randomized studies have suggested that GP ablation, as an adjunctive strategy, might achieve better clinical outcomes in patients undergoing radiofrequency-based PVI for both paroxysmal and nonparoxysmal AF. In these patients, vagal reactions (VR) such as vagally mediated bradycardia or asystole are thought to reflect intrinsic cardiac ANS modulation and/or denervation. Vagal reactions occurring during cryoballoon- (CB-) based PVI have been previously reported; however, little is known on resulting ANS modulation and/or prevalence and significance of vagal reactions during PVI with the CB technique. We conducted a review of prevalence, putative mechanisms, and significance of VR during CB-based PVI.

scholarly journals Autonomic mechanism for initiation of rapid firing from atria and pulmonary veins: evidence by ablation of ganglionated plexi

2009 ◽  
Vol 84 (2) ◽  
pp. 245-252 ◽  
Author(s):  
Z. Lu ◽  
B. J. Scherlag ◽  
J. Lin ◽  
L. Yu ◽  
J.-H. Guo ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Rapid Firing ◽  
Ganglionated Plexi
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