Evaluation of Catheter Ablation of Periatrial Ganglionic Plexi in Patients With Atrial Fibrillation

Danik, Stephan; Neužil, Petr; d’Ávila, André; Malchano, Zachary J.; Královec, Štěpán; Ruskin, Jeremy N.; Reddy, Vivek Y.

doi:10.1016/j.amjcard.2008.04.064

Cited by 53 publications

(34 citation statements)

References 25 publications

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“…73 It is likely, that both electrophysiological and autonomic remodeling factors are involved in the "AF begets AF" phenomenon, thereby allowing the coexistence of the neurally based drug resistant focal AF and the myocardial based macroor multiple reentrant forms of AF. 74 Indeed, this coexistence, previously predicted 19,20 could explain the findings of Danik et al 58 who induced AF after acute GP ablation in 17 of 18 patients but showed these findings, the GP Hyperactivity Hypothesis has been proposed to explain, at least in part, the mechanistic basis for the focal form of AF. In addition, the co-existence of both a myocardial and neural conduction system in the atrium can aid in understanding the greater success for AF ablation by the combined use of PVI and GP ablations.…”

Section: Progression Of Af: From Paroxysmal To Long Standing Persistementioning

confidence: 55%

“…For example, in the small series reported by Scanavacca et al 55 in which GP ablation alone accounted for a success rate of 25%, the addition of PV isolation showed a 100% success during a follow up of 250 days. In the study by Danik et al [58], even though, with GP ablation, in 18/19 patients AF was acutely inducible, the same group with both GP ablation and PVI after a 1 year follow-up had only one recurrence of AF; a success rate of 94%. In a larger series of 83 patients with paroxysmal and persistent AF, Nakagawa et al 60 reported that the freedom from symptomatic AF and AT at 22 months was 86% after a single procedure targeting both GP and performing an antral type PVI.…”

Section: Ablation Strategies Not Involving Pvimentioning

confidence: 99%

“…After a 1 year follow-up in 58 patients with persistent and long standing persistent AF (75%) and paroxysmal AF (25%) they reported an overall success rate of 86% during a short follow-up of 7 months. Danik et al 58 reported on a series of 18 patients whose AF dusurgical approaches which have performed both PVI and GP ablation. For example, in the small series reported by Scanavacca et al 55 in which GP ablation alone accounted for a success rate of 25%, the addition of PV isolation showed a 100% success during a follow up of 250 days.…”

Section: Ablation Strategies Not Involving Pvimentioning

confidence: 99%

See 2 more Smart Citations

The Autonomic Nervous System and Atrial Fibrillation: The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation

Scherlag¹,

Nakagawa²,

Patterson³

et al. 2009

J.A.F.I.B

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Section: Progression Of Af: From Paroxysmal To Long Standing Persistementioning

confidence: 55%

Section: Ablation Strategies Not Involving Pvimentioning

confidence: 99%

Section: Ablation Strategies Not Involving Pvimentioning

confidence: 99%

See 1 more Smart Citation

The Autonomic Nervous System and Atrial Fibrillation: The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation

Scherlag¹,

Nakagawa²,

Patterson³

et al. 2009

J.A.F.I.B

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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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“…However, the mechanism of this is not well understood, and there is controversy surrounding the abovementioned results. [23][24][25][26][27] It is unknown whether AER is modulated by the ANS, and the influence of ganglionated plexuses ablation on AER and AF inducibility remains controversial.…”

mentioning

confidence: 99%

Effect of Epicardial Fat Pad Ablation on Acute Atrial Electrical Remodeling and Inducibility of Atrial Fibrillation

Dong

Zhang

Yang

et al. 2010

Circ J

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Background: Atrial electrical remodeling (AER) is the underlying mechanism of atrial fibrillation (AF). The present study investigated the impact of epicardial fat pad (FP) ablation on acute AER (AAER) and inducibility of AF. Methods and Results: AAER was performed in 28 mongrel dogs through 4-h rapid atrial pacing (RAP). Before RAP, 14 dogs (ablation group) underwent FP ablation, and the other 14 (control group) underwent a sham procedure. The atrial effective refractory period (ERP) and vulnerability window (VW) of AF were measured with and without bilateral cervical vagosympathetic nerve stimulation (VNS) at the high right atrium, ostium of the coronary sinus (CS) and distal CS before and after every hour of RAP. In the control group, ERP was markedly shortened in the first 2 h of RAP and then stabilized. AF was only slightly induced. After RAP, the time course of ERP with and without VNS was similar. VNS significantly shortened ERP and increased VW before and after RAP. In the ablation group, ERP was significantly prolonged after FP ablation. Moreover, neither VNS nor RAP shortened the ERP or increased the VW. AF could not be induced (VW=0).Conclusions: RAP resulted in AAER, which may be mediated and aggravated by autonomic activity. Epicardial FP ablation generated denervation, which not only abolishes AF inducibility but also prevents RAP-mediated AAER. (Circ J 2010; 74: 885 - 894)

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Evaluation of Catheter Ablation of Periatrial Ganglionic Plexi in Patients With Atrial Fibrillation

Cited by 53 publications

References 25 publications

The Autonomic Nervous System and Atrial Fibrillation: The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation

The Autonomic Nervous System and Atrial Fibrillation: The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation

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

Effect of Epicardial Fat Pad Ablation on Acute Atrial Electrical Remodeling and Inducibility of Atrial Fibrillation

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