Right anterior ganglionated plexus: The primary target of cardioneuroablation?

Hu, Feng; Zheng, Lihui; Liang, Erpeng; Ding, Ligang; Wu, Lingmin; Chen, Gang; Fan, Xiaohan; Yao, Yan

doi:10.1016/j.hrthm.2019.07.018

Cited by 118 publications

(106 citation statements)

References 33 publications

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“…By using left and right atrial ablation, they detected syncope free survival in 40 (93.1%) of 43 patients in a mean followup of 45.1±22 months. Similar results were recently demonstrated by Hu et al (10) with left-sided strategy. During follow-up of 21.4±13.1 months, 106 (92.2%) of 115 patients had no syncope recurrence.…”

Section: Discussionsupporting

confidence: 91%

Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias

Güler¹,

Aksu²

2020

ejcm

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Long-term efficacy and safety are still uncertain in patients with vagally mediated bradyarrhythmias (VMB) undergoing cardioneuroablation (CNA). Thus, we assessed the outcome of CNA in those patients during long-term follow-up using clinical history in outpatient visits. Materials and Methods: A total of 27 patients (42.7±14 years; 17 (63.0% men) were included in this study. The main mechanism involved in the occurrence of syncope was vasovagal syncope in 16 (59.3%) patients, functional atrioventricular block (AVB) in seven (25.9%) patients, and sinus bradycardia or pauses in four (14.8%) patients. The ablation strategy included right-sided or bi-atrial ablation of ganglionated plexi. Syncope recurrences were assessed clinically during follow-up. Results: Acute procedural endpoints were achieved in 26 (96.2%) of cases. During a median follow-up period of 52 months (IQR, 28-56 months), all but 2 (7.4%) of 27 patients were free of new syncope. Significant clinical and ECG improvement was detected in four (57.1%) of seven patients with AVB. In the remaining two patients except one patient with acute failure, pacemaker was implanted despite no syncope recurrence because evening time variable-degree AVB episodes were seen on follow-up Holter recordings. Procedure related complication was not seen in any cases. Symptoms attributed inappropriate sinus tachycardia was observed in two patients. Conclusion: Our results demonstrate long-term efficacy and safety of cardiovascular autonomic neuropathy in patients with VMB. Randomized controlled studies are needed to define long-term efficacy and safety of cardioneuroablation.

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Section: Discussionsupporting

confidence: 91%

Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias

Güler¹,

Aksu²

2020

ejcm

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“…Anatomically, the right superior GP is located between anterior wall of the right superior pulmonary vein and the superior vena cava 1 . According to a recently published study, ablation of this GP region promoted a significant increase in heart rate, which was not observed during ablation at other ganglion plexi of the left atrium 10 . Furthermore, PVI initiated from the right superior GP could effectively inhibit VR occurrence and significantly increase heart rate during procedure 11 .…”

Section: Discussionmentioning

confidence: 99%

Why is pulmonary vein isolation not enough for vagal denervation in all cases?

Aksu

Güler

Bozyel

et al. 2020

Pacing Clinical Electrophis

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“…Each of these GPs innervate the PVs and the surrounding left atrial myocardium [ 52 ]. The superior left GP (SLGP) is located superolateral and medial to the left superior PV and extends around its root [ 16 , 44 , 53 ] ( Figure 3 ). The SLGP is associated with both the sino-atrial (SA) and atrio-ventricular (AV) nodes, influencing sinus and ventricular rate [ 54 , 55 ].…”

Section: Ganglionated Pleximentioning

confidence: 99%

“…A recent study by Hu et al indicates that endocardial ablation of the right anterior GPs produced a significant increase in heart rate in 93% of patients [ 16 ]. In addition, there appears to be an essential role for the right anterior GP which inhibits positive vagal responses and increases heart rate during pulmonary vein isolation (PVI) [ 90 ].…”

Section: Gp Ablation For Afmentioning

confidence: 99%

“…The incidence of atrial arrhythmias is reported to reduce when ANS innervation is significantly decreased [ 14 , 15 ]. The activity of the intrinsic cardiac ANS is found to be disrupted in cases of AF, with studies associating vagal interference with networks of GPs [ 16 , 17 ]. GPs are normally found in close proximity with epicardial fat pads and reside in discrete locations on the atria and ventricles, particularly surrounding the pulmonary veins (PV) and great vessels [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation

Avazzadeh

McBride

O’Brien³

et al. 2020

JCM

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Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.

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Right anterior ganglionated plexus: The primary target of cardioneuroablation?

Cited by 118 publications

References 33 publications

Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias

Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias

Why is pulmonary vein isolation not enough for vagal denervation in all cases?

Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation

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