Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation

John, Leah; Mullis, Andin; Payne, Jason; Tung, Roderick; Aksu, Tolga; Winterfield, Jeffrey

doi:10.19102/icrm.2021.120405

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Однако такой подход зачастую приводил к индукции фибрилляции предсердий во время стимуляции и не являлся высокоспецифичным. В связи с этим, был предложен подход к аблации анатомических зон предсердий с наибольшей концентрацией ГС [17][18][19].…”

Section: обсуждение полученных результатовunclassified

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

Vakhrushev,

Condori Leandro,

Korobchenko

et al. 2024

Vestnik aritmologii

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Aim. To study the potential applicability of transcatheter laser ablation for the destruction of atrial ganglionated plexi (GP) zones and the safety of this technique in relation to inadvertent esophageal damage.Methods. This was a two-stage investigation: (1) ex vivo experiments: the risk of esophageal damage during ablation on the dorsal (posterior) left atrial (LA) wall was assessed; three swine organ complexes were used, which included the heart, lungs and esophagus; (2) in vivo experiments assessing the effects of laser catheter ablation of GP zones on the inducibility of atrial fibrillation (AF) and changes in atrial effective refractory period - included 13 landrace pigs (average weight 38.8±1.2 kg).Ex vivo: laser catheter ablations were performed from the endocardial surface of the LA towards the esophagus with a power of 15 watts of varying duration; ablation was performed under thermal scanning of the LA and esophagus; then a macroscopic examination of the myocardial and esophageal walls was performed.In vivo: before and after catheter laser ablation (15 W) of the GP zones in the right atrium and atrial septum, atrial ERP was assessed with programmed stimulation, and AF induction with high-frequency (33 Hz, 2 min) stimulation was evaluated. At the end of the experiment, the animals were euthanized, and the heart and lungs were collected in a single unit.Results. Ex vivo experiments: in two cases, damage to the endocardium of the LA was detected at an exposure time of 30 s. Damage to the esophagus was observed with a longer exposure time (> 30 seconds) with a 11.3-15.4°C increase in temperature. In the in vivo experiments, 78 laser applications (6±1 in one swine) were delivered to the posterior wall of the right atrium and atrial septum. Atrial effective refractory period was not altered after ablation (183±20 ms vs 186±18 ms, P=0.99). At the baseline, AF was induced in 12 out of 13 animals (92%). After ablation, AF was induced in 7 animals (54%) (P=0.03). There was a trend toward a decrease in the duration of AF after laser ablation of GP zones (18 [5; 141] vs. 2 [0; 14] s after ablation, P=0.06). Transmural damage was observed in 46% of the hearts. No damage to extra-cardiac structures was detected.Conclusion. Ex vivo, laser ablation on the dorsal (posterior) wall of the LA with a power of 15 W and duration <30 s does not lead to visible damage to the esophagus. Laser ablation of atrial GP zones is feasible and reduces the inducibility of AF. No change in atrial effective refractory period is detected following GP zones ablation, when performed from the right atrium.

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Section: обсуждение полученных результатовunclassified

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

Vakhrushev,

Condori Leandro,

Korobchenko

et al. 2024

Vestnik aritmologii

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“…Adaption of mapping techniques currently used in electrophysiology labs would be desirable. In this context, the use of electroanatomical mapping is already being widely used for GP localization in the treatment of syncope [ 116 , 117 ] and sinus bradycardia [ 118 ]. Initial work has also been performed in relation to AF [ 119 , 120 ].…”

Section: Future Workmentioning

confidence: 99%

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

O’Brien¹,

Reilly²,

Coffey³

et al. 2023

JCDD

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Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies.

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“…The new methodology of high-density mapping in combination with an auto-algorithm fraction mapping system, developed by Aksu et al to treat AF and VVS [54], may allow for better and faster localization of GPs during ablation, as a complement to anatomicallyguided approaches. Recent studies investigating the treatment of VVS using this method [73,74] have shown improved results in these patients [54] compared to combined spectral analysis with HFS-mapping approaches (Tables 1 and 2). Additional studies using this mapping strategy, in addition to longer follow-ups for possible VVS recurrence, are still lacking.…”

Section: Fractionation High-density Mappingmentioning

confidence: 99%

Ganglionated Plexus Ablation Procedures to Treat Vasovagal Syncope

Yarkoni,

Rehman,

Bajwa

et al. 2023

IJMS

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Vasovagal syncope (VVS) refers to a heterogeneous group of conditions whereby the cardiovascular reflexes normally controlling the circulation are interrupted irregularly in response to a trigger, resulting in vasodilation, bradycardia, or both. VVS affects one-third of the population at least once in their lifetime or by the age of 60, reduces the quality of life, and may cause disability affecting certain routines. It poses a considerable economic burden on society, and, despite its prevalence, there is currently no proven pharmacological treatment for preventing VVS. The novel procedure of ganglionated plexus (GP) ablation has emerged rapidly in the past two decades, and has been proven successful in treating syncope. Several parameters influence the success rate of GP ablation, including specific ablation sites, localization and surgical techniques, method of access, and the integration of other interventions. This review aims to provide an overview of the existing literature on the physiological aspects and clinical effectiveness of GP ablation in the treatment of VVS. Specifically, we explore the association between GPs and VVS and examine the impact of GP ablation procedures as reported in human clinical trials. Our objective is to shed light on the therapeutic significance of GP ablation in eliminating VVS and restoring normal sinus rhythm, particularly among young adults affected by this condition.

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Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation

Cited by 4 publications

References 9 publications

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

Ganglionated Plexus Ablation Procedures to Treat Vasovagal Syncope

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