Catheter ablation of atrial fibrillation (AF) has generally consisted of eliminating
pulmonary vein (PV) triggers initiating AF
1
or modifying the adjacent atrial substrate to isolate the PVs.
2
Mapping and ablation of complex fractionated atrial electrograms, thought to be responsible
for maintaining AF, also have been reported.
- 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.
Circulation. 2001; 104: 2539-2544
3
However, all of these strategies likely are associated with varying degrees of denervation,
as suggested by experimental,
4
clinical, and systematic analysis of the effects of modification of autonomic tone
on the outcome of AF ablation.
5
,
- 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.
Circulation. 2004; 109: 327-334
6
,
7
Anatomically, ganglionated plexuses are located predominantly in the left atrium
(LA), around the PVs.
8
,
9
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.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart RhythmAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.N Engl J Med. 1998; 339: 659-666
- Atrial electrical remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation.Circulation. 2001; 104: 2539-2544
- A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate.J Am Coll Cardiol. 2004; 43: 2044-2053
- The intrinsic cardiac nervous system and atrial fibrillation.Curr Opin Cardiol. 2006; 21: 51-54
- Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation.Circulation. 2004; 109: 327-334
- Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation.J Interv Card Electrophysiol. 2005; 13: 1-6
- Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation.Heart Rhythm. 2006; 3: 387-396
- Gross and microscopic anatomy of the human intrinsic cardiac nervous system.Anat Rec. 1997; 247: 289-298
- Morphology, distribution, and variability of the epicardial neural ganglionated subplexuses in the human heart.Anat Rec. 2000; 259: 353-382
- Selective in situ parasympathetic control of the canine sinoatrial and atrioventricular nodes.Circ Res. 1973; 32: 393-401
- Autonomically induced conversion of pulmonary vein focal firing into atrial fibrillation.J Am Coll Cardiol. 2005; 45: 1878-1886
Article info
Publication history
Published online: May 04, 2006
Identification
Copyright
© 2006 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
