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How to perform ablation of the parasympathetic ganglia of the left atrium

  • Robert Lemery
    Correspondence
    Address reprint requests and correspondence: Dr. Robert Lemery, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada.
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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      Catheter ablation of atrial fibrillation (AF) has generally consisted of eliminating pulmonary vein (PV) triggers initiating AF
      • Haïssaguerre M.
      • Jaïs P.
      • Shah D.C.
      • Takahashi A.
      • Hocini M.
      • Quiniou G.
      • Garrigue S.
      • Le Mouroux A.
      • Le Métayer P.
      • Clémenty J.
      Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
      or modifying the adjacent atrial substrate to isolate the PVs.
      • Pappone C.
      • Oreto G.
      • Rosanio S.
      • Vicedomini G.
      • Tocchi M.
      • Gugliotta F.
      • Salvati A.
      • Dicandia C.
      • Calabro M.P.
      • Mazzone P.
      • Ficarra E.
      • Di Gioia C.
      • Gulletta S.
      • Nardi S.
      • Santinelli V.
      • Benussi S.
      • Alfieri O.
      Atrial electrical remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation.
      Mapping and ablation of complex fractionated atrial electrograms, thought to be responsible for maintaining AF, also have been reported.
      • Nademanee K.
      • McKenzie J.
      • Kosar E.
      • Schwab M.
      • Sunsaneewitayakul B.
      • Vasavakul T.
      • Khunnawat C.
      • Ngarmukos T.
      A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate.
      However, all of these strategies likely are associated with varying degrees of denervation, as suggested by experimental,
      • Scherlag B.J.
      • Po S.
      The intrinsic cardiac nervous system and atrial fibrillation.
      clinical, and systematic analysis of the effects of modification of autonomic tone on the outcome of AF ablation.
      • Pappone C.
      • Santinelli V.
      • Manguso F.
      • Vicedomini G.
      • Gugliotta F.
      • Augello G.
      • Mazzone P.
      • Tortoriello V.
      • Landoni G.
      • Zangrillo A.
      • Lang C.
      • Tomita T.
      • Mesas C.
      • Mastella E.
      • Alfieri O.
      Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation.
      • Scherlag B.J.
      • Nakagawa H.
      • Jackman W.M.
      • Yamanashi W.S.
      • Patterson E.
      • Po S.
      • Lazzara R.
      Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation.
      • Lemery R.
      • Birnie D.
      • Tang S.L.
      • Green M.
      • Gollob M.
      Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation.
      Anatomically, ganglionated plexuses are located predominantly in the left atrium (LA), around the PVs.
      • Armour J.A.
      • Murphy D.A.
      • Yuan B.X.
      • MacDonald S.
      • Hopkins D.
      Gross and microscopic anatomy of the human intrinsic cardiac nervous system.
      • Pauza D.H.
      • Skripka V.
      • Pauziene N.
      • Stropus R.
      Morphology, distribution, and variability of the epicardial neural ganglionated subplexuses in the human heart.
      Mapping of ganglionated plexuses can be performed using high-frequency stimulation. This article reviews the methodology and practical aspects of incorporating this approach during AF ablation.
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      References

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        A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate.
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