Document Detail


Catheter ablation of right atrial ganglionated plexi in patients with vagal paroxysmal atrial fibrillation.
MedLine Citation:
PMID:  22147839     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Catheter ablation of ganglionated plexi (GP) in the left atrium has been proposed in different subgroup of patients with atrial fibrillation (AF). Anatomic studies found a high prevalence of GP in the posterior surface of the right atrium (RA). Experimental data suggested the potential role of right atrial GP in the AF initiation and maintenance. The aim of our study was to assess the efficacy of GP ablation in RA in patients with vagal AF.
METHODS AND RESULTS: Thirty-four patients without structural heart diseases were randomly assigned for a selective ablation procedure targeted on the elimination of vagal reflex evoked by high frequency stimulation or an extensive approach at anatomic sites of GP. All patients underwent Holter ECG and heart rate variability evaluation at baseline and at 3, 6, 12, and 18 months of follow-up. At a mean follow-up of 19.7±5.2 months, AF recurred in 5 of 17 patients with anatomic ablation and in 13 of 17 patients with a selective approach (P=0.01). No patient had major complications. After ablation, heart rate variability parameters showed a significant parasympathetic (and sympathetic) denervation in the first 6 months, which was more prominent in patients with anatomic GP ablation and in those without AF recurrence.
CONCLUSIONS: This study demonstrates that in a selected population of vagal paroxysmal AF, the anatomic ablation of GPs in the RA is effective in about 70% of patients. These results confirm that atrial vagal denervation can abolish AF, as suggested by experimental and clinical data.
Authors:
Leonardo Calò; Marco Rebecchi; Luigi Sciarra; Lucia De Luca; Alessandro Fagagnini; Lorenzo Maria Zuccaro; Pietro Pitrone; Serena Dottori; Maurizio Porfirio; Ermenegildo de Ruvo; Ernesto Lioy
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2011-12-06
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  5     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-15     Completed Date:  2012-04-17     Revised Date:  2012-05-24    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  22-31     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Policlinico Casilino, ASL Roma B, Rome, Italy. leonardo.calo@tin.it
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / physiopathology,  surgery*
Catheter Ablation / methods*
Denervation / methods*
Electrocardiography
Female
Follow-Up Studies
Heart Atria / innervation*,  physiopathology
Heart Conduction System / physiopathology,  surgery*
Humans
Male
Middle Aged
Retrospective Studies
Tachycardia, Paroxysmal / physiopathology,  surgery*
Treatment Outcome
Vagus Nerve / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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