Anatomic Approach for Ganglionic Plexi Ablation in Patients With Paroxysmal Atrial Fibrillation

Katritsis, Demosthenes G.; Giazitzoglou, Eleftherios; Sougiannis, Demetrios; Goumas, Nicolaos; Paxinos, George; Camm, A. John

doi:10.1016/j.amjcard.2008.03.062

Cited by 117 publications

(96 citation statements)

References 26 publications

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“…One of the major challenges has been the lack of a sensitive and specific means to localize the GP in patients. 117,118,119,120 Whereas several small studies have reported improved outcomes using an anatomically based approach to localize autonomic ganglia, these findings have not been replicated by other investigators. 121,122 A recent prospective randomized surgical AF ablation study reported no improvement of outcomes by ablation of autonomic ganglia.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 95%

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2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 95%

“…The rotor concept has been applied to AF, and subsequent studies have confirmed its ability to account for the AF-suppressing actions of Na + channel blockers. 119 …”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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1,769

1,468

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“…Just as mentioned above, some studies [32,34] have applied radiofrequency ablation on anatomic GP sites and obtained satisfactory effect. However, even with the same anatomically based GP mapping, the above mentioned research results by Katritsis et al [31] are disappointing. For this, we also did a series of research.…”

Section: Possible Reasons For the Variable Long-term Success Rate Of mentioning

confidence: 94%

“…The researchers believed in that GP ablation could not prevent the immediate induction of AF. In 2008, Katritsis et al [31] also conducted GP ablation in 19 cases of paroxysmal AF by means of anatomically based GP ablation, and compared the results with 19 cases of age, gender-matched patients with conventional circumferential PV ablation. The results showed that in the process of ablation, vagal response occurred only in 4 cases, and during the mean follow-up of 1 year, the recurrent rate of arrhythmia was 74% and 37% in GP ablation group and circumferential PV ablation group, respectively.…”

Section: Gp Ablation For Afmentioning

confidence: 99%

Ganglionated Plexi Ablation for Atrial Fibrillation

Zhang¹,

Gao²,

Wang³

et al. 2012

Atrial Fibrillation - Basic Research and Clinical Applications

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“…However, the results of this strategy have been mixed. [73][74][75][76][77][78][79] Choi et al recently demonstrated that in ambulatory dogs, all episodes of atrial tachyarrhythmias were preceded by bursts of autonomic activity (both parasympathetic and sympathetic), 6 suggesting that vagal activity alone may not explain arrhythmogenesis in the atria. Additionally, intracardiac ganglia not only provide some parasympathetic and sympathetic efferent innervation of the atria, they also process afferent information as well.…”

Section: Vagal Stimulation Vagal Stimulation and Atrial Electrophysiomentioning

confidence: 99%

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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The interplay between the central nervous system and cardiac electrophysiology is fundamental, and becomes obvious each time one's pulse quickens in response to stress. Normally, cardiac neurohormonal regulation is accomplished through the balanced effects of sympathetic and parasympathetic autonomic stimulation, along with the hormonal regulation of the renin-angiotensinaldosterone system (RAAS). Autonomic and hormonal input modulate multiple facets of cellular electrophysiology -action potential duration, ion channel kinetics and intracellular calcium dynamics (just to name a few) -which translate into macroscopic manifestations of autonomic modulation such as heart rate variability, atrioventricular (AV) conduction time and QT interval variability.1 Therefore, it is no surprise that neurohormonal regulation of cardiac electrophysiology is an area of active investigation for its potential antiarrhythmic effects. Recent reviews have focused on the efficacy of neurohormonal modulation, via non-pharmacological methods, to enhance heart failure treatment. 2,3 This review will attempt to provide a state-of-the-art on the potential antiarrhythmic efficacy of renal artery denervation, spinal cord stimulation and direct vagal stimulation. Neurohormonal Control in the Normal and Failing HeartAutonomic control of cardiac physiology is often conceptualised as parasympathetic (cholinergic) and sympathetic (adrenergic) innervation existing in a 'yin and yang' balance under normal circumstances; however, this concept may be over-simplified. 4 In reality, the intrinsic cardiac nervous system, composed of several ganglia located primarily posterior to the atria, likely acts as a 'little brain' of the heart -it provides efferent input to the myocardium, collects afferent signals on a beat-to-beat basis and performs some integrative functions on its own, all under the tonic modulation of extrinsic sympathetic and parasympathetic input (see Figure 1). 4-8The ganglia are predominantly composed of cholinergic neurons; however, sympathetic efferent neurons are also present. Due to the complex interconnectivity between the ganglia, afferent mechanosensory, nociceptive and chemosensory signals from all four chambers of the heart may be processed within a single ganglion. 4 Such interconnectivity implies that predicting the effect of stimulation or ablation of a particular ganglion may be difficult, because each ganglion performs multiple functions. 7,9Abstract Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension.Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonom...

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Anatomic Approach for Ganglionic Plexi Ablation in Patients With Paroxysmal Atrial Fibrillation

Cited by 117 publications

References 26 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Ganglionated Plexi Ablation for Atrial Fibrillation

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

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