Document Detail


Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation.
MedLine Citation:
PMID:  16567283     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Numerous reports have demonstrated an association between autonomic tone and atrial fibrillation (AF). Pulmonary vein (PV) denervation during catheter ablation of AF has been shown to significantly reduce recurrence of AF. OBJECTIVES: The purpose of this study was to assess the safety and efficacy of high-frequency stimulation at mapping cardiac ganglionated plexuses in patients undergoing catheter ablation of AF. METHODS: Fourteen patients with a history of symptomatic AF underwent a single transseptal approach and electroanatomic mapping of the left atrium, right atrium, and coronary sinus. Using high-frequency stimulation with patients under general anesthesia (20-50 Hz, 5-15 V, pulse width 10 ms), mapping of ganglionated plexuses was performed. Radiofrequency (RF) ablation was performed during AF guided by complex fractionated atrial electrograms. Lesions were mostly delivered circumferentially in the antral area of the PVs, predominantly over and adjacent to regions of ganglionated plexuses. RESULTS: There was a mean of 4 +/- 1 (range 2-6) ganglionated plexuses per patient, and a mean total of 3 +/- 1 RF applications were delivered over positive vagal sites. Although a vagal response occurred infrequently during ablation (0.9%), postablation high-frequency stimulation failed to provoke a vagal response in 30 (88%) of 34 previously positive vagal sites that underwent ablation. CONCLUSION: Ganglionated plexuses can be precisely mapped using high-frequency stimulation and are located predominantly in the path of lesions delivered during ablation of AF. Objective documentation of modification of autonomic tone can be documented in the majority of patients. Future studies are required to determine the specific role of mapping and targeting of ganglionated plexuses in patients undergoing catheter ablation of AF.
Authors:
Robert Lemery; David Birnie; Anthony S L Tang; Martin Green; Michael Gollob
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Publication Detail:
Type:  Journal Article     Date:  2006-02-28
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  3     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-28     Completed Date:  2006-09-21     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  387-96     Citation Subset:  IM    
Affiliation:
Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada. RLemery@ottawaheart.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Afferent Pathways / physiopathology
Aged
Anti-Arrhythmia Agents / therapeutic use
Atrial Fibrillation / drug therapy,  physiopathology*,  surgery*
Atrial Function
Autonomic Nervous System / physiopathology
Body Surface Potential Mapping*
Catheter Ablation* / adverse effects
Efferent Pathways / physiopathology
Electric Stimulation
Electrophysiologic Techniques, Cardiac
Endocardium / innervation,  physiopathology*
Feasibility Studies
Follow-Up Studies
Heart Conduction System / physiopathology
Humans
Male
Middle Aged
Recurrence
Research Design
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

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


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