Selective ganglionated plexi ablation for paroxysmal atrial fibrillation

Pokushalov, Evgeny; Romanov, Alexander; Shugayev, Pavel; Artyomenko, Sergey; Shirokova, Natalya; Туров, А. Н.; Katritsis, Demosthenes G.

doi:10.1016/j.hrthm.2009.05.018

Cited by 210 publications

(210 citation statements)

References 21 publications

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“…One of the major challenges has been the lack of a sensitive and specific means to localize the GP in patients. 117,118,119,120 Whereas several small studies have reported improved outcomes using an anatomically based approach to localize autonomic ganglia, these findings have not been replicated by other investigators. 121,122 A recent prospective randomized surgical AF ablation study reported no improvement of outcomes by ablation of autonomic ganglia.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 98%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 98%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

View full text Add to dashboard Cite

“…88 Other studies have localised GP by use of high-frequency simulation, although data have suggested that an anatomic approach is preferred over high-frequency stimulation or identification of areas with vagal responses, which are both insensitive methods to identify GP. 89 Katritsis and colleagues studied the benefit of GP ablation by randomising 242 patients with paroxysmal AF to standard PVI alone, GP ablation alone or PVI with additional GP ablation. GP were anatomically targeted by ablating at their expected locations around the pulmonary veins.…”

Section: The Influence Of the Autonomic Nervous System And Ganglionatmentioning

confidence: 99%

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF), the most common sustained arrhythmia, is a leading cause of stroke, and is associated with significant morbidity and mortality worldwide. Despite its frequency, clinical importance, and advances in technology and our knowledge of the molecular, ionic and physiological fundamentals of cardiac electrophysiology, our limited understanding of the mechanisms that initiate and sustain AF has prevented us from being able to truly cure this arrhythmia with antiarrhythmic drugs and/or ablation. This contrasts with other arrhythmias, such as AV nodal tachycardia or circus movement tachycardia using an accessory pathway, which have well-defined mechanisms and circuits that can be safely targeted with high rates of cure. The observations that AF may have different mechanisms in different patients, and that paroxysmal, persistent and permanent forms of AF may differ in how they are initiated and sustained, only serves to reinforce our lack of understanding of this ubiquitous arrhythmia. Historical Mechanisms of Atrial Fibrillation and the Multiple Wavelet HypothesisInterest and understanding of the mechanism of AF began to take form in the early 1900s. Given the chaotic and irregular nature of AF on the surface electrocardiogram, rapid firing of automatic atrial foci was considered a potential mechanism. However, after the seminal work of Mayer 1 , Mines 2 and Garrey 3 in laying the foundation for describing and understanding reentrant arrhythmias, atrial reentrant circuits emerged as the likely drivers of AF.4-7 Although these theories were conceptually sound, it was impossible to prove a specific mechanism with the technology of the time. Moe et al. demonstrated that it was probabilistically unlikely that a large number of simultaneous wavefronts would all die out simultaneously, and AF would therefore perpetuate. However, if the number of simultaneous wavelets were small and/or below a critical value (between 15 and 30 in Moe's computer model), 9 at some point all reentrant wavefronts would be simultaneously extinguished, and AF would therefore terminate. 8,9 Allessie et al. provided experimental evidence supporting this mechanism in a canine heart model of AF where four to six simultaneous reentrant wavelets were needed to sustain arrhythmia. 10 Further evidence supporting multiple wavelets in AF was demonstrated in a separate model, which evaluated the effect of various antiarrhythmic drugs on canine myocardium. This model demonstrated that termination of AF was associated with a reduction AbstractAtrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, yet our understanding of the mechanisms that initiate and sustain this arrhythmia remains quite poor. Over the last 50 years, various mechanisms of AF have been proposed, yet none has been consistently observed in both experimental studies and in humans. Recently, there has been increasing interest in understanding how spiral waves or rotors -which are specific, organised forms of functional reentry -su...

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“…Therefore, many studies have come up with reasonable explanations regarding the differences between positive vagal response sites and actual anatomic GP sites. Just as mentioned above, some studies [32,34] have applied radiofrequency ablation on anatomic GP sites and obtained satisfactory effect. However, even with the same anatomically based GP mapping, the above mentioned research results by Katritsis et al [31] are disappointing.…”

Section: Possible Reasons For the Variable Long-term Success Rate Of mentioning

confidence: 98%

“…Among them, 2 patients suffered from atrial flutter besides the recurrence of AF, suggesting that anatomically-based GP ablation might be inferior to circumferential PV ablation. In 2009, Pokushalov et al [32] compared the results of the selective GP ablation identified by applying HFS with those of the anatomically based regional GP ablation in 80 cases (40 cases in each group) of paroxysmal AF. Ablation targets of selective GP were the vagal response sites evoked by HFS.…”

Section: Gp Ablation For Afmentioning

confidence: 99%