Ganglionated Plexi Ablation for Longstanding Persistent Atrial Fibrillation

Pokushalov, Evgeny; Romanov, A. B.; Artemenko, Sergey; Шабанов, В. В.; Стенин, И. Г.; Karaskov, Aleksandr; Katritsis, Demosthenes G.

doi:10.1016/s0735-1097(11)60025-9

Cited by 19 publications

(32 citation statements)

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“…Driessen et al showed that atrial tachycardia was more prevalent in patients randomly assigned to GP ablation than in controls. We believe that this risk of proarrhythmia is due in part to the use of RFA, which is not tissue selective and thereby creates substrate for atrial tachycardia through myocardial injury …”

Section: Discussionmentioning

confidence: 99%

Electroporation of epicardial autonomic ganglia: Safety and efficacy in medium‐term canine models

Padmanabhan

Naksuk

Killu

et al. 2019

Cardiovasc electrophysiol

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Background Endocardial radiofrequency ablation of epicardial ganglionic plexus (GP) for atrial fibrillation (AF) is complicated by myocardial damage. Objectives We hypothesized that an epicardial approach with a novel nitinol catheter system capable of causing irreversible electroporation (IRE) with direct current (DC) could selectively and permanently destroy GP without collateral myocardial injury. Methods Acute studies and medium‐term terminal studies (mean survival, 1137 days) were performed with seven dogs. In the acute studies, DC was used to target epicardial GP within the transverse sinus, oblique sinus, vein of Marshall, and right periaortic space. Successful electroporation was defined as the presence of ablative lesions in the GP without collateral myocardial damage. A four‐point integer system was used to classify histologic changes in tissue harvested from the ablation sites. Atrial effective refractory period (AERP) was measured during the acute and medium‐term studies. Results For six dogs in the medium‐term studies, the postablation period was uneventful without complications. Lesions were successfully created at 20 of 21 sites (95.2%) with more than minimal myocardial damage in one dog. An increase in AERP occurred in both atria during the acute studies but was maintained only in the right atrium at medium‐term follow‐up (5032 milliseconds). No dog had damage to the esophagus, adjacent great arteries, or pulmonary veins. Conclusions This proof‐of‐concept study suggests that safe, effective, and selective epicardial ablation of GP can be performed with DC by IRE with minimal collateral myocardial damage.

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Section: Discussionmentioning

confidence: 99%

Electroporation of epicardial autonomic ganglia: Safety and efficacy in medium‐term canine models

Padmanabhan

Naksuk

Killu

et al. 2019

Cardiovasc electrophysiol

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“…In fact, it is not uncommon for patients to note an increase in resting heart rate for several months after AF ablation. Some centers have advocated specific targeting of the cardiac GPs in order to improve the success rate of AF ablation 56,57 . GPs can be identified by detection of a hypotensive and bradycardic response to high frequency…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Atrial Fibrillation Ablation: Indications, Emerging Techniques, and Follow-Up

Gerstenfeld

Duggirala

2015

Progress in Cardiovascular Diseases

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“…25 The evidence in support of this possibility is mixed, and ganglionated plexi are most likely responsible for only a subset of the observed CFAE areas. 26,27 Furthermore, we have performed a subgroup analysis to evaluate the effect of different variables (such as antiarrhythmic medication use or RA ablation) on the derived parameters and patterns. The small sample size limits the power of these analyses .…”

Section: Study Limitationsmentioning

confidence: 99%