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Ganglionated plexuses (GPs) are epicardial structures, implicated in arrhythmogenesis, that can be located by triggering their physiological effect via endocardial high frequency stimulation (HFS). Mapping and ablation of GP sites may be an effective treatment for AF. Further research is hampered by regulatory and clinical issues relating to commonly used stimulators. A novel current-controlled stimulator was developed to overcome some of these.
To assess efficacy and reproducibility of localising atrial GP using a novel current-controlled HFS (Tau-20) in comparison to the Grass S88 with SIU5 (voltage-controlled).
In 31 patients undergoing clinically-indicated AF ablation, standard mapping catheters (Navistar™, TacticathTM) were used to deliver HFS to the left atrial endocardium from either the Tau20 or Grass S88 with SIU5. AV dissociation (AVD-GP) and atrial ectopy (ET-GP) in response to HFS were tagged on 3D electroanatomic mapping systems (CARTO™ & Precision™) to assess current output threshold for GP detection, reproducibility of the Tau20, creation of high density GP maps and efficacy of RF ablation in abolishing the GP effect.
Mean output to identify GP was 29 mA (n=12). Reproducibility comparing the two stimulators was 100% for AVD-GP (n=6) (Kappa=1, SE of kappa=0, 95% CI 1 to 1) and 100% for ET-GP (n=16) (Kappa=1, SE of kappa =0, 95% CI 1 to 1). Reproducibility using the Tau20 was 95% for AVD-GP (n=38) (Kappa = 0.64, SE of kappa =0.23, 95% CI 0.19 to 1) and 100% for ET-GP (n=13) (Kappa = 1, SE of kappa =0, 95% CI 1 to 1). Figure 1 shows a high-density GP map. Ablation abolished autonomic effects at 166 AVD-GP and 118 ET-GP (n=11).