Outcome of anatomic ganglionated plexi ablation to treat paroxysmal atrial fibrillation: a 3-year follow-up study

Mikhaylov, Evgeny N.; Kanidieva, A.; Sviridova, Nina; Abramov, Mikhail; Гуреев, С. В.; Szili-Török, Tamás; Lebedev, Dmitry

doi:10.1093/europace/euq416

Cited by 69 publications

(55 citation statements)

References 27 publications

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“…Two small studies (n = 54) have compared the efficacy of GP ablation alone versus PVI, and one meta-analysis using these two studies has been published. [15][16][17] Comparing GP ablation alone with PVI, GP ablation alone was not superior in maintaining sinus rhythm. The group receiving GP ablation alone had higher early recurrence and lower AF-free survival compared to the PVI group.…”

Section: Ablation Of Ganglionated Pleximentioning

confidence: 98%

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Is the Atrial Neural Plexis A Therapeutic Target in Atrial Fibrillation?

Choi

Chen

2015

Methodist DeBakey Cardiovascular Journal

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Section: Ablation Of Ganglionated Pleximentioning

confidence: 98%

“…15,16,21 With the first approach, HFS was used to elicit a parasympathetic response (hypotension or atrioventricular block), whereas the latter approach using anatomical location ablated four major atrial GP areas without first performing HFS. Selective GP ablation could be verified if there was vagal response by HFS.…”

Section: Ablation Of Ganglionated Pleximentioning

confidence: 99%

Is the Atrial Neural Plexis A Therapeutic Target in Atrial Fibrillation?

Choi

Chen

2015

Methodist DeBakey Cardiovascular Journal

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“…34 It has been suggested that ganglionated plexi may have a role in the initiation and maintenance of both paroxysmal and non-paroxysmal AF. [35][36][37][38][39][40][41] Localisation is usually performed on the endocardium either anatomically, by vagal response following high-frequency stimulation, or by Fourier transform in sinus rhythm. 35,37 Although ganglionated plexi ablation significantly reduces AF recurrence, the long-term success rate is lower than after PVI.…”

Section: Pathophysiology Of Atrial Fibrillation and Atrial Fibrillatimentioning

confidence: 99%

“…35,37 Although ganglionated plexi ablation significantly reduces AF recurrence, the long-term success rate is lower than after PVI. [35][36][37][38][39][40][41] Interestingly, in addition to PVI, the suppression of ganglionated plexi response -particularly that observed during cryoablation -may reduce AF recurrence. 40,41 Although many authors believe that additional ablations are required for non-paroxysmal AF or some paroxysmal AF, no randomised studies have consistently shown which strategy to use.…”

Section: Pathophysiology Of Atrial Fibrillation and Atrial Fibrillatimentioning

confidence: 99%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

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“…Seventy one percent of the patients (40/56) did not suffer from the recurrence of arrhythmia over the mean follow-up of 12 months, suggesting that local ablation applying to the left atrial GPs might become an alternative therapy for paroxysmal AF. In 2010, Mikhaylov et al [36] reported the long-term follow-up results of a group undergoing GP ablation. The case control study included 70 cases of paroxysmal AF, of which 35 cases underwent GP ablation and 35 circumferential PV ablation.…”

Section: Gp Ablation For Afmentioning

confidence: 99%