Impact of Anatomically Guided Ganglionated Plexus Ablation on Electrical Firing from Isolated Pulmonary Veins.
BACKGROUND
The mechanisms underlying atrial fibrillation (AF) initiation and pulmonary vein isolation (PVI) effectiveness remain unclear. Ganglionated plexus (GPs) have been implicated in AF initiation and maintenance. In this study, we evaluated the impact of GP ablation in patients with pulmonary vein (PV) firing after PVI.


METHODS
Patients with drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation therapy with PVI were screened. Among 840 cases over a 3.75-year period, 12 cases were identified with persistent PV firing (left = 4 and right = 8) after PVI was achieved and left atrial sinus rhythm restored. Adjacent GP ablation was performed anatomically and followed if necessary by additional PV ablation.


RESULTS
In eight patients, PV firing was terminated during GP ablation outside of the circumferential ablation line. In one patient, additional PV ablation resulted in cessation of PV firing and in the remaining three patients, firing could not be terminated by GP ablation or additional PVI.


CONCLUSION
GP ablation outside of wide antral circumferential line frequently results in the cessation of rapid firing from electrically isolated PVs. These observations suggest that interactions between left atrium and PV beyond electrical conduction warrant consideration in AF mechanisms.
['Jiang|Ru-Hong|RH|', 'Hu|Gen-Sheng|GS|', 'Liu|Qiang|Q|', 'Sheng|Xia|X|', 'Sun|Ya-Xun|YX|', 'Yu|L U|LU|', 'Zhang|Pei|P|', 'Zhang|Zu-Wen|ZW|', 'Chen|Shi-Quan|SQ|', 'Ye|Yang|Y|', 'Zhu|Jun|J|', 'Fu|Guo-Sheng|GS|', 'Jiang|Chen-Yang|CY|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D059925:Anatomic Landmarks D001281:Atrial Fibrillation D018780:Body Surface Potential Mapping D017115:Catheter Ablation D005260:Female D005725:Ganglia, Autonomic D006329:Heart Conduction System D006801:Humans D008297:Male D008875:Middle Aged D011667:Pulmonary Veins D025321:Surgery, Computer-Assisted D016896:Treatment Outcome
ganglionated plexus ablation atrial fibrillation PV firing AF mechanisms