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Liu J, Sun F, Sun J, Ba Y, Zhao W, Zhang Z, Liu L, Zhang S, Yin X. Changes in Heart Rate after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation and Sinus Bradycardia. Int Heart J 2023; 64:606-613. [PMID: 37518342 DOI: 10.1536/ihj.22-714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This study aimed to evaluate the effect of circumferential pulmonary vein isolation (CPVI) on autonomic nervous function and prognosis in patients with paroxysmal atrial fibrillation (AF) with or without sinus bradycardia.A total of 66 patients with paroxysmal AF accompanied by sinus bradycardia and who underwent CPVI were recruited as the sinus bradycardia group. A total of 91 patients with paroxysmal AF but without sinus bradycardia and who underwent catheter ablation were selected as the control group. After surgical contraindications were eliminated, CPVI was performed by three-dimensional mapping system. 24-hour dynamic electrocardiogram was used to observe the changes of heart rate before and 2 days after surgery.A total of 45 (68%) and 51 (56%) patients in the sinus bradycardia and control groups, respectively, maintained sinus rhythm. There was an increase in heart rate after CPVI in both groups. The standard deviation of normal-to-normal (NN) intervals (SDNN), standard deviation of the average NN intervals (SDANN), low frequency (LF), and LF/high frequency (HF) in the sinus bradycardia and control groups decreased after CPVI (P < 0.01). Moreover, SDANN was higher in patients with sinus bradycardia treated by successful ablation than in those with recurrence (P < 0.01), while SDNN, a standard statistical measure of heart rate variability (rMSSD), LF, and HF were significantly lower in patients with sinus bradycardia (P < 0.05).CPVI was able to produce a significant reduction effect on vagal nerve and sympathetic activity regardless of whether patients with paroxysmal AF had sinus bradycardia. Moreover, CPVI exerted a certain influence on the success rate of AF catheter ablation.
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Affiliation(s)
- Jiyi Liu
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Fengzhi Sun
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Jiao Sun
- Department of Neuroelectrophysiology, Affiliated Zhongshan Hospital of Dalian University
| | - Yunbo Ba
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Weilong Zhao
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Zhipeng Zhang
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Lu Liu
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Shulong Zhang
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University
| | - Xiaomeng Yin
- Department of Cardiovascular, The First Affiliated Hospital of Dalian Medical University
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Alteration of Skin Sympathetic Nerve Activity after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation. J Pers Med 2022; 12:jpm12081286. [PMID: 36013235 PMCID: PMC9409853 DOI: 10.3390/jpm12081286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Autonomic system plays a pivotal role in the pathogenesis of paroxysmal atrial fibrillation (AF). Skin sympathetic nerve activity (SKNA) is a noninvasive tool for assessing sympathetic tone. However, data on changes in SKNA after ablation are limited. Here, we retrospectively enrolled 37 patients with symptomatic drug-refractory paroxysmal AF who underwent pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) or cryoablation (CBA). SKNA was measured from the chest and right arm 1 day prior to ablation, as well as 1 day and 3 months after ablation. One day after ablation, the SKNA-Arm increased from 517.1 µV (first and third quartiles, 396.0 and 728.0, respectively) to 1226.2 µV (first and third quartiles, 555.2 and 2281.0), with an increase of 179.8% (125% and 376.0%) (p < 0.001); the SKNA-Chest increased from 538.2 µV (first and third quartiles, 432.9 and 663.9) to 640.0 µV (first and third quartiles, 474.2 and 925.6), with an increase of 108.3% (95.6% and 167.9%) (p = 0.004), respectively. In those without recurrence, there was a significant increase in SKNA 1 day after ablation as compared with those before ablation. Twelve patients received SKNA measurement 3 months after ablation; both SKNA-Arm (p = 0.31) and SKNA-Chest (p = 0.27) were similar to those before ablation, respectively. Among patients with symptomatic drug-refractory paroxysmal AF receiving PVI, increased SKNA was observed 1 day after ablation and returned to the baseline 3 months after ablation. Elevation of SKNA was associated with lower early and late recurrences following ablation.
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Yin J, Wang Y, Li X, Xue M, Cheng W, Li X, Shi Y, Wang Y, Lu H, Hu H, Yan S. Successful radiofrequency ablation of swallowing-induced atrial tachycardia arising from left superior ganglionated plexus. J Int Med Res 2022; 50:3000605211070755. [PMID: 35441549 PMCID: PMC9047854 DOI: 10.1177/03000605211070755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A man in his early 40s developed palpitations brought on by swallowing and was
found to have short runs of atrial tachycardia induced by swallowing solid food.
Atrial tachycardia during swallowing was documented on electrocardiography and
24-hour Holter monitoring. No structural heart disease or esophageal disorders
were found by echocardiography. The patient then underwent an
electrophysiological study and catheter ablation. We mapped the left atrium with
a multipolar mapping catheter while the patient swallowed bread and found that
the earliest endocardial breakthrough was on the left anterior superior atrium,
where the left superior ganglionated plexus was located. We successfully
eliminated the paroxysmal atrial tachycardia at this site. Interestingly, in the
process of ablation, atrioventricular node reentrant tachycardia was triggered.
After the slow-pathway ablation procedure, no further tachycardia was
induced.
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Affiliation(s)
- Jie Yin
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ye Wang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Xiaolu Li
- Department of Emergency, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Mei Xue
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wenjuan Cheng
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Xinran Li
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yugen Shi
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yu Wang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Hangji Lu
- Shandong First Medical University, Jinan, China
| | - Hesheng Hu
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Suhua Yan
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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Correlation analysis between heart rate variability, epicardial fat thickness, visfatin and AF recurrence post radiofrequency ablation. BMC Cardiovasc Disord 2022; 22:65. [PMID: 35193492 PMCID: PMC8862205 DOI: 10.1186/s12872-022-02496-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background The aim of the present study is to investigate the possible correlation between heart rate variability (HRV), epicardial fat thickness (EFT), visfatin and AF recurrence post radiofrequency ablation. Methods Data of 337 AF patients to whom radiofrequency ablation therapy had been initiated at our hospital over the past three years were evaluated. The patients enrolled were divided into the non-recurrence group (102 patients) and the recurrence group (235 patients) according to AF recurrence in the preceding 12 months. General data in the two groups were collected and HRV, EFT, and visfatin levels were comprehensively compared for each patients of the two groups. Results The recurrence group showed significantly higher results in rMSSD, PNN50, HF, total EFT, and visfatin but with evidently lower results in LF/HF when comparing the non-recurrence group (P < 0.05). The significantly different general variables in the general data and laboratory parameters, rMSSD, PNN50, HF, total EFT, visfatin, LF/HF were used as independent variables, and AF recurrence post radiofrequency ablation was used as dependent variables. Logistic regression analysis revealed that the risk factors of AF recurrence post radiofrequency ablation were rMSSD, PNN50, HF, total EFT, visfatin, and LF/HF, and the difference was statistically significant (P < 0.05). Conclusion HRV, EFT, visfatin appear to show high association with AF recurrence post radiofrequency ablation.
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Celotto C, Sánchez C, Mountris KA, Laguna P, Pueyo E. Location of Parasympathetic Innervation Regions From Electrograms to Guide Atrial Fibrillation Ablation Therapy: An in silico Modeling Study. Front Physiol 2021; 12:674197. [PMID: 34456743 PMCID: PMC8385640 DOI: 10.3389/fphys.2021.674197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
The autonomic nervous system (ANS) plays an essential role in the generation and maintenance of cardiac arrhythmias. The cardiac ANS can be divided into its extrinsic and intrinsic components, with the latter being organized in an epicardial neural network of interconnecting axons and clusters of autonomic ganglia called ganglionated plexi (GPs). GP ablation has been associated with a decreased risk of atrial fibrillation (AF) recurrence, but the accurate location of GPs is required for ablation to be effective. Although GP stimulation triggers both sympathetic and parasympathetic ANS branches, a predominance of parasympathetic activity has been shown. This study aims was to develop a method to locate atrial parasympathetic innervation sites based on measurements from a grid of electrograms (EGMs). Electrophysiological models representative of non-AF, paroxysmal AF (PxAF), and persistent AF (PsAF) tissues were developed. Parasympathetic effects were modeled by increasing the concentration of the neurotransmitter acetylcholine (ACh) in randomly distributed circles across the tissue. Different circle sizes of ACh and fibrosis geometries were considered, accounting for both uniform diffuse and non-uniform diffuse fibrosis. Computational simulations were performed, from which unipolar EGMs were computed in a 16 × 1 6 electrode mesh. Different distances of the electrodes to the tissue (0.5, 1, and 2 mm) and noise levels with signal-to-noise ratio (SNR) values of 0, 5, 10, 15, and 20 dB were tested. The amplitude of the atrial EGM repolarization wave was found to be representative of the presence or absence of ACh release sites, with larger positive amplitudes indicating that the electrode was placed over an ACh region. Statistical analysis was performed to identify the optimal thresholds for the identification of ACh sites. In all non-AF, PxAF, and PsAF tissues, the repolarization amplitude rendered successful identification. The algorithm performed better in the absence of fibrosis or when fibrosis was uniformly diffuse, with a mean accuracy of 0.94 in contrast with a mean accuracy of 0.89 for non-uniform diffuse fibrotic cases. The algorithm was robust against noise and worked for the tested ranges of electrode-to-tissue distance. In conclusion, the results from this study support the feasibility to locate atrial parasympathetic innervation sites from the amplitude of repolarization wave.
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Affiliation(s)
- Chiara Celotto
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Carlos Sánchez
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Konstantinos A. Mountris
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Pablo Laguna
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Esther Pueyo
- Aragon Institute of Engineering Research-I3A-, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER in Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
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Gimelli A, Liga R, Agostini D, Bengel FM, Ernst S, Hyafil F, Saraste A, Scholte AJHA, Verberne HJ, Verschure DO, Slart RHJA. The role of myocardial innervation imaging in different clinical scenarios: an expert document of the European Association of Cardiovascular Imaging and Cardiovascular Committee of the European Association of Nuclear Medicine. Eur Heart J Cardiovasc Imaging 2021; 22:480-490. [PMID: 33523108 DOI: 10.1093/ehjci/jeab007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac sympathetic activity plays a key role in supporting cardiac function in both health and disease conditions, and nuclear cardiac imaging has always represented the only way for the non-invasive evaluation of the functional integrity of cardiac sympathetic terminals, mainly through the use of radiopharmaceuticals that are analogues of norepinephrine and, in particular, with the use of 123I-mIBG imaging. This technique demonstrates the presence of cardiac sympathetic dysfunction in different cardiac pathologies, linking the severity of sympathetic nervous system impairment to adverse patient's prognosis. This article will outline the state-of-the-art of cardiac 123I-mIBG imaging and define the value and clinical applications in the different fields of cardiovascular diseases.
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Affiliation(s)
- Alessia Gimelli
- Department of Imaging, Fondazione Toscana/CNR Gabriele Monasterio1, via Moruzzi n.1, Pisa 56124, Italy
| | - Riccardo Liga
- Cardiac-Thoracic-Vascular Department, Università di Pisa, Pisa, Italy
| | - Denis Agostini
- Department of Nuclear Medicine, University Hospital of Normandy, CHU Cote de Nacre, Caen, France
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK
| | - Fabien Hyafil
- Department of Nuclear Medicine, European Hospital Georges-Pompidou, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland.,Heart Center, Turku University Hospital, Turku, Finland
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Derk O Verschure
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Zaans Medical Center, Zaandam, the Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, The Netherlands.,Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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7
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Hanna P, Buch E, Stavrakis S, Meyer C, Tompkins JD, Ardell JL, Shivkumar K. Neuroscientific therapies for atrial fibrillation. Cardiovasc Res 2021; 117:1732-1745. [PMID: 33989382 PMCID: PMC8208752 DOI: 10.1093/cvr/cvab172] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.
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Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Eric Buch
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Christian Meyer
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Kirchfeldstraße 40, 40217 Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - John D Tompkins
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Jeffrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
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8
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Stirrup J, Gregg S, Baavour R, Roth N, Breault C, Agostini D, Ernst S, Underwood SR. Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation. J Nucl Cardiol 2020; 27:1939-1950. [PMID: 30694425 DOI: 10.1007/s12350-018-01535-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Ablating left atrial (LA) ganglionated plexi (GP), identified invasively by high-frequency stimulation (HFS) during pulmonary vein isolation (PVI), may reduce atrial fibrillation (AF) recurrence. 123I-metaiodobenzylguanidine (123I-mIBG) solid-state SPECT LA innervation imaging (LAII) has the spatial resolution to detect LAGP non-invasively but this has never been demonstrated in clinical practice. METHODS 20 prospective patients with paroxysmal AF scheduled for PVI underwent 123I-mIBG LAII. High-resolution tomograms, reconstructed where possible using cardiorespiratory gating, were co-registered with pre-PVI cardiac CT. Location and reader confidence (1 [low] to 3 [high]) in discrete 123I-mIBG LA uptake areas (DUAs) were recorded and correlated with HFS. RESULTS A total of 73 DUAs were identified, of which 59 (81%) were HFS positive (HFS +). HFS + likelihood increased with reader confidence (92% [score 3]). 64% of HFS-negative DUAs occurred over the lateral and inferior LA. Cardiorespiratory gating reduced the number of DUAs per patient (4 vs 7, P = .001) but improved: HFS + predictive value (76% vs 49%); reader confidence (2 vs 1, P = .02); and inter-observer, intra-observer, and inter-study agreement (κ = 0.84 vs 0.68; 0.82 vs 0.74; 0.64 vs 0.53 respectively). CONCLUSIONS 123I-mIBG SPECT/CT LAII accurately and reproducibly identifies GPs verified by HFS, particularly when reconstructed with cardiorespiratory gating.
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Affiliation(s)
- J Stirrup
- Department of Cardiology, Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, RG1 5AN, United Kingdom.
| | - S Gregg
- Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - R Baavour
- Spectrum Dynamics Medical, Caesarea, Israel
| | - N Roth
- Spectrum Dynamics Medical, Caesarea, Israel
| | - C Breault
- Spectrum Dynamics Medical, Caesarea, Israel
| | - D Agostini
- Department of Nuclear Medicine, CHU Caen and Normandy University EA 4650, Caen, France
| | - S Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- Cardiovascular Research Center, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - S R Underwood
- Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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9
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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation. J Clin Med 2020; 9:jcm9103081. [PMID: 32987820 PMCID: PMC7598705 DOI: 10.3390/jcm9103081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.
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10
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Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic Nervous System Dysfunction: JACC Focus Seminar. J Am Coll Cardiol 2020; 73:1189-1206. [PMID: 30871703 DOI: 10.1016/j.jacc.2018.12.064] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 12/20/2022]
Abstract
Autonomic nervous system control of the heart is a dynamic process in both health and disease. A multilevel neural network is responsible for control of chronotropy, lusitropy, dromotropy, and inotropy. Intrinsic autonomic dysfunction arises from diseases that directly affect the autonomic nerves, such as diabetes mellitus and the syndromes of primary autonomic failure. Extrinsic autonomic dysfunction reflects the changes in autonomic function that are secondarily induced by cardiac or other disease. An array of tests interrogate various aspects of cardiac autonomic control in either resting conditions or with physiological perturbations from resting conditions. The prognostic significance of these assessments have been well established. Clinical usefulness has not been established, and the precise mechanistic link to mortality is less well established. Further efforts are required to develop optimal approaches to delineate cardiac autonomic dysfunction and its adverse effects to develop tools that can be used to guide clinical decision-making.
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Affiliation(s)
- Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
| | - Rishi Arora
- Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Una Buckley
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
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11
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Guckel D, Schmidt A, Gutleben KJ, Körber B, Fischbach T, Horstkotte D, Sommer P, Nölker G. Pulmonary vein isolation and beyond: Predictive value of vagal reactions in second-generation cryoballoon ablation for the outcome of persistent atrial fibrillation. Heart Rhythm 2019; 17:600-606. [PMID: 31841715 DOI: 10.1016/j.hrthm.2019.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is gaining increasing acceptance in the treatment of persistent (per) atrial fibrillation (AF). The cardiac autonomic nervous system plays a pivotal role in the regulation of AF. OBJECTIVE We evaluated the impact of vagal reactions (VRs), as a surrogate marker for autonomic nervous system modulation, on the outcome of CBA in patients (pts) with perAF. METHODS A total of 250 consecutive pts (mean age 63.9 ± 10.0 years; 175 pts, 70% male) undergoing primary second-generation CBA for perAF were studied. VRs were defined as bradycardia <40 beats/min, asystole, or higher-degree atrioventricular block. Follow-up visits at 3, 6, and 12 months included 7-day Holter electrocardiograms. RESULTS VRs were recorded in 61 pts (24%). These pts showed a significantly reduced recurrence rate of AF (5%) than did those without VRs (log-rank, P < .01). Univariate Cox regression analyses confirmed VRs as a strong predictor of AF-free survival (hazard ratio [HR] 0.10; P < .01). Female sex (HR 1.71; P = .02), preprocedural tachycardia (HR 1.01; P = .01), and AF (HR 1.75; P = .01) before CBA at admission were revealed as predictors of AF recurrence. Multivariate regression model calculation solely identified VRs (HR 0.11; 95% confidence interval 0.03-0.34; P < .01) and male sex (HR 0.57; 95% confidence interval 0.36-0.89; P = .01) as independent predictors of AF-free survival. CONCLUSION VR is an independent predictor of AF-free survival after CBA for perAF.
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Affiliation(s)
- Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Anke Schmidt
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Klaus-Jürgen Gutleben
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Britta Körber
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fischbach
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Georg Nölker
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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12
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Radiofrequency versus cryoballoon ablation for atrial fibrillation: an argument for a 'cryo-first' approach. Curr Opin Cardiol 2019; 35:13-19. [PMID: 31688135 DOI: 10.1097/hco.0000000000000700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Radiofrequency and cryoballoon ablation are the two most common modalities for catheter ablation of atrial fibrillation. Radiofrequency, being more prevalent and having existed for a longer period, is often utilized for patients' first ablations, despite the efficiency and efficacy of the cryoballoon tool. Here we examine the advantages of the cryoballoon for its use in first-time ablation of atrial fibrillation. RECENT FINDINGS The FIRE & ICE trial is established as conclusive evidence of the noninferiority of cryoballoon ablation to radiofrequency ablation in terms of efficacy. Since the study, cryoballoon has evolved in both form and technique, suggesting need for repeat consideration of the advantages of cryoablation over radiofrequency ablation. The second-generation cryoballoon has led to greater efficiency in achieving permanent pulmonary vein isolation, reducing complications, and reducing procedure times. SUMMARY There are advantages to the use of cryoballoon which could increase success of first-time ablations, delaying need for repeat procedure and lowering overall burden on patients and the healthcare system. Cryoballoon ablation should be considered for first-time ablation in patients with paroxysmal or persistent atrial fibrillation.
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13
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Wyn Davies D, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol 2019; 50:1-55. [PMID: 28914401 PMCID: PMC5633646 DOI: 10.1007/s10840-017-0277-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | - Joseph G Akar
- Yale University School of Medicine, New Haven, CT, USA
| | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, UK
| | - Peng-Sheng Chen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, UK
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY, USA
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA, USA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, USA
- The National Center for Cardiovascular Research Carlos III (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO, USA
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Stanley Nattel
- Montreal Heart Institute, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
- University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, ON, Canada
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Pandozi C, Lavalle C, Ficili S, Russo M, Galeazzi M, Rio T, Centurion Aznaran C, Malacrida M, Colivicchi F. Reasons for successful clinical outcome following pulmonary vein isolation despite lack of persistent LA‐PV conduction block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1056-1062. [DOI: 10.1111/pace.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/23/2019] [Accepted: 05/16/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | - Carlo Lavalle
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Sabina Ficili
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Maurizio Russo
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Marco Galeazzi
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Teresa Rio
- Division of CardiologySan Filippo Neri Hospital Rome Italy
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A Review of the Use of Cryoballoon Ablation for the Treatment of Persistent Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Vesela J, Osmancik P, Herman D, Prochazkova R. Changes in heart rate variability in patients with atrial fibrillation after pulmonary vein isolation and ganglionated plexus ablation. Physiol Res 2019; 68:49-57. [PMID: 30433795 DOI: 10.33549/physiolres.933710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone in the treatment of patients with paroxysmal atrial fibrillation (PAF). Some research has suggested studies have shown that modification of ganglionated plexuses (GP), performed with PVI, could lead to even better outcomes. The aim of this study was to determine the effect of PVI on the autonomic system. Heart rate variability (HRV) was used as a marker of autonomic system activity. Twenty-six PAF patients underwent PVI (PVI group) and twenty patients underwent PVI plus a GP ablation (GP group). In each group, 5 min long ECG signals obtained before and after the electrophysiology EP study were analyzed. Time and frequency domain parameters were evaluated. Vagal responses during ablation were observed in 15 (58 %) patients in the PVI group and in 12 (60 %) patients in the GP group. The change in normalized power in the low frequency (LF) and in the LF/HF ratio, before and after ablation, was statistically significant in both groups (LF/HF 2.6+/-1.6 before vs. 1.4+/-1.7 after ablation in PVI group and LF/HF 3.3+/-2.6 before vs. 1.8+/-1.9 after ablation in the GP group). Relative to heart rate variability parameters, there were no differences between PVI and PVI + plus GP ablation.
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Affiliation(s)
- J Vesela
- Third Internal - Cardiology Clinic, Cardiocenter, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
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17
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Cui J, Gonzalez MD, Blaha C, Hill A, Sinoway LI. Sympathetic responses induced by radiofrequency catheter ablation of atrial fibrillation. Am J Physiol Heart Circ Physiol 2019; 316:H476-H484. [PMID: 30525895 DOI: 10.1152/ajpheart.00470.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiofrequency catheter ablation (RFCA) is a frequently performed procedure in patients with atrial fibrillation. Prior studies have shown that the RFCA may directly stimulate vagal afferents during the procedure, whereas the vagal tone assessed by heart rate variability (HRV) is lowered weeks after the RFCA procedure. The effects of RFCA performed in the left atrium on sympathetic nerve activity have not been assessed. In the present study, we hypothesized that RFCA would lower muscle sympathetic nerve activity (MSNA) during ablation and would raise MSNA 1 day postablation. A total of 18 patients were studied. In protocol 1 ( n = 10), electrocardiogram, blood pressure, and MSNA in the peroneal nerve were recorded through the RFCA procedure performed in the electrophysiology laboratory. In protocol 2, eight patients were studied before the procedure and 1 day postablation. RFCA led to a decrease in MSNA immediately after the procedure (25.4 ± 3.2 to 17.2 ± 3.8 bursts/min, P < 0.05). Cardiac parasympathetic activity was determined using indexes of HRV and increased during the procedure. One day postablation, MSNA was above baseline values (21.3 ± 3.7 to 35.7 ± 2.6 bursts/min, P < 0.05). HRV indexes of cardiac parasympathetic activity fell, and the HRV index of sympathovagal balance was not significantly altered. The results show that RFCA raised cardiac parasympathetic activity and decreased MSNA during the procedure. One day postablation, MSNA rose and cardiac parasympathetic activity fell. In addition, RFCA evokes differentiated sympathetic responses directed to the heart and skeletal muscles. NEW & NOTEWORTHY The effects of radiofrequency catheter ablation performed in the left atrium on muscle sympathetic nerve activity (MSNA) have not been assessed. The results of this study show that radiofrequency catheter ablation raised cardiac parasympathetic activity and decreased MSNA during the procedure. One day postablation, MSNA rose and cardiac parasympathetic activity fell. We speculate that the partial autonomic afferent denervation induces these effects on autonomic activity.
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Affiliation(s)
- Jian Cui
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Mario D Gonzalez
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Cheryl Blaha
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Ashley Hill
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Penn State College of Medicine , Hershey, Pennsylvania
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18
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Additional Ganglion Plexus Ablation During Thoracoscopic Surgical Ablation of Advanced Atrial Fibrillation: Intermediate Follow-Up of the AFACT Study. JACC Clin Electrophysiol 2018; 5:343-353. [PMID: 30898238 DOI: 10.1016/j.jacep.2018.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The authors report the 2-year follow-up results of the AFACT (Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery) study. BACKGROUND The AFACT study randomized patients with advanced atrial fibrillation (AF) to thoracoscopic AF ablation with or without additional ganglion plexus (GP) ablation. At 1 year, there was no difference in AF freedom between the groups, but autonomic modification may exert beneficial effects during longer follow-up. METHODS Patients underwent thoracoscopic pulmonary vein isolation, with additional left atrial lines in persistent AF patients, and were randomized 1:1 to ablation of the 4 major GP and Marshall ligament or no GP ablation (control). Patients were followed every 3 months up to 18 months and at 24 months. After an initial 3-month blanking period, all antiarrhythmic drugs were discontinued. RESULTS The authors randomized 240 patients (age 59 ± 8 years, 73% men, 68% enlarged left atrium, 60% persistent AF), of whom 228 patients (95%) completed follow-up. Freedom of any atrial tachyarrhythmia did not differ significantly between the GP group (55.6%) and control group (56.1%) (p = 0.91), with no difference in paroxysmal (p = 0.60) or persistent AF patients (p = 0.88). Documented AF recurrences were similar between treatment arms: 11.8% (GP) versus 11.0% (control) had >3 recurrences/year (p = 0.82). More persistent AF patients (17.0%) than paroxysmal (3.2%) had >3 recurrences per year (p < 0.01). Despite this, 78% of patients were off antiarrhythmic drugs after 2 years. No procedural-related complications occurred in the second year. CONCLUSIONS Additional GP ablation during thoracoscopic surgery for advanced AF does not affect freedom of AF recurrence. As GP ablation is associated with more major procedural complications, it should not routinely be performed. (Atrial Fibrillation Ablation and Autonomic Modulation via Thorascopic Surgery [AFACT]; NCT01091389).
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19
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMS(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace 2018; 20:157-208. [PMID: 29016841 PMCID: PMC5892164 DOI: 10.1093/europace/eux275] [Citation(s) in RCA: 340] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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20
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 708] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Kviesulaitis V, Puodziukynas A, Pauza DH, Zabiela V, Kazakevicius T, Vaitkevicius R, Diržinauskas E, Semaška V, Strazdas A, Unikaite R, Rysevaite K, Pauziene N, Zaliunas R. Heart rate variability after radiofrequency ablation of epicardial ganglionated plexuses on the ovine left atrium. BMC Cardiovasc Disord 2017; 17:292. [PMID: 29233092 PMCID: PMC5727886 DOI: 10.1186/s12872-017-0727-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Ganglionated plexuses (GP) are terminal parts of cardiac autonomous nervous system (ANS). Radiofrequency ablation (RFA) for atrial fibrillation (AF) possibly affects GP. Changes in heart rate variability (HRV) after RFA can reflect ANS modulation. Methods Epicardial RFA of GP on the left atrium (LA) was performed under the general anesthesia in 15 mature Romanov sheep. HRV was used to assess the alterations in autonomic regulation of the heart. A 24 − hour ECG monitoring was performed before the ablation, 2 days after it and at each of the 12 following months. Ablation sites were evaluated histologically. Results There was an instant change in HRV parameters after the ablation. A standard deviation of all intervals between normal QRS (SDNN), a square root of the mean of the squared differences between successive normal QRS intervals (RMSSD) along with HRV triangular index (TI), low frequency (LF) power and high frequency (HF) power decreased, while LF/HF ratio increased. Both the SDNN, LF power and the HF power changes persisted throughout the 12 − month follow − up. Significant decrease in RMSSD persisted only for 3 months, HRV TI for 6 months and increase in LF/HF ratio for 7 months of the follow − up. Afterwards these three parameters were not different from the preprocedural values. Conclusions Epicardial RFA of GP’s on the ovine left atrium has lasting effect on the main HRV parameters (SDNN, HF power and LF power). The normalization of RMSSD, HRV TI and LF/HF suggests that HRV after epicardial RFA of GPs on the left atrium might restore over time.
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Affiliation(s)
- Vilius Kviesulaitis
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania.
| | - Aras Puodziukynas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | | | - Vytautas Zabiela
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Tomas Kazakevicius
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | | | - Evaldas Diržinauskas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Vytenis Semaška
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Antanas Strazdas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Ruta Unikaite
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Kristina Rysevaite
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Neringa Pauziene
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Lithuanian University of Health Sciences, Eivenių 2, LT-50161, Kaunas, Lithuania
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Kuyumcu MS, Ozeke O, Cay S, Ozcan F, Bayraktar MF, Kara M, Vicdan M, Acar B, Aydogdu S, Topaloglu S, Aras D. The short-term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1193-1199. [PMID: 28850690 DOI: 10.1111/pace.13179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices. METHOD A total of 45 patients were enrolled with symptomatic, drug refractory paroxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge. RESULTS The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence. CONCLUSION This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.
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Affiliation(s)
- Mevlut Serdar Kuyumcu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Fırat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Muhammed Fatih Bayraktar
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Murat Vicdan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sinan Aydogdu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
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23
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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm 2017; 14:e445-e494. [DOI: 10.1016/j.hrthm.2017.07.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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24
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1370] [Impact Index Per Article: 195.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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25
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm 2017; 33:369-409. [PMID: 29021841 PMCID: PMC5634725 DOI: 10.1016/j.joa.2017.08.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- AFL, atrial flutter
- Ablation
- Anticoagulation
- Arrhythmia
- Atrial fibrillation
- Atrial flutter
- Atrial tachycardia
- CB, cryoballoon
- CFAE, complex fractionated atrial electrogram
- Catheter ablation
- LA, left atrial
- LAA, left atrial appendage
- LGE, late gadolinium-enhanced
- LOE, level of evidence
- MRI, magnetic resonance imaging
- OAC, oral anticoagulation
- RF, radiofrequency
- Stroke
- Surgical ablation
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Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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26
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Choi EK, Zhao Y, Everett TH, Chen PS. Ganglionated plexi as neuromodulation targets for atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1485-1491. [PMID: 28833764 DOI: 10.1111/jce.13319] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/26/2022]
Abstract
The autonomic nervous system plays an important role in the genesis of atrial fibrillation and is one of the candidate targets for atrial fibrillation therapy. This review focuses on the role of the autonomic nervous system in atrial fibrillation development and discusses the results of the ganglionated plexi catheter and surgical ablation in preclinical and clinical studies. The heart is innervated by the extrinsic and intrinsic autonomic nervous systems. The intrinsic autonomic nervous system consists of multiple ganglionated plexi and axons, which innervate the neighboring atrial myocardium and control their electrophysiological properties. Abnormal autonomic innervation has been observed in an animal model of atrial fibrillation and in humans. Direct recordings of autonomic nerve activity in canine models showed that atrial tachyarrhythmia episodes were invariably preceded by intrinsic cardiac autonomic nerve activity, thus supporting the importance of intrinsic cardiac autonomic nerve activity as the triggers for atrial tachyarrhythmia. Targeting ganglionated plexi with catheter ablation improves the outcomes of paroxysmal atrial fibrillation ablation in addition to pulmonary vein antrum isolation. Ablation of ganglionated plexi alone without pulmonary vein isolation is also useful in controlling paroxysmal atrial fibrillation in some patients. However, surgical ganglionated plexi ablation in patients with a large left atrium, persistent atrial fibrillation, and/or a history of prior catheter ablation does not result in additional benefits. These different outcomes suggest that ganglionated plexi ablation is effective in managing patients with paroxysmal atrial fibrillation, but its effects in patients with persistent atrial fibrillation and advanced atrial diseases might be limited.
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Affiliation(s)
- Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ye Zhao
- Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Thomas H Everett
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peng-Sheng Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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27
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Xu FQ, Yu RH, Guo JJ, Bai R, Liu N, An YI, Guo XY, Tang RB, Long DEY, Sang CH, DU X, Dong JZ, Ma CS. Catheter Ablation of Recurrent Paroxysmal Atrial Fibrillation: Is Gap-Closure Combining Ganglionated Plexi Ablation More Effective? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:672-682. [PMID: 28251658 DOI: 10.1111/pace.13064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND For repeat treatment with paroxysmal atrial fibrillation (PAF) recurrence, gap-closure at pulmonary vein ostia alone is not enough. Many recent studies indicated that ganglionated plexi (GPs) denervation could reduce the recurrence of AF. However, it is unclear whether the clinical outcomes of additional GP ablation plus pulmonary veins (PVs ) reisolation during a repeat procedure were associated with less recurrence in PAF patients. The purpose of this study was to evaluate if a repeat procedure of GP ablation (GPA) combining repeated procedure of pulmonary vein isolation (re-PVI), i.e., gap-closure, can offer additional benefit for patients with PAF recurrence. METHOD A total of 123 consecutive patients with PAF recurrence who underwent success repeat procedures were retrospectively analyzed in our center (2014-2015). Note that 64 patients (group 1, GPA group) were performed with GPA plus re-PVI, while 59 patients (group 2, re-PVI group) had re-PVI (gap-closure) alone. Organized atrial tachycardias (OATs) documented or induced at the end of the procedure were all mapped and ablated. Patients were scheduled for a 12-month follow-up. Clinical presentation and outcome data for the two groups were assessed. RESULT At the 12-month follow-up 58 of 64 patients (90.6%) in group 1 and 46 of 59 patients (78%) in group 2 remained in sinus rhythm (SR) off antiarrhythmia drugs (AADs) (P = 0.045). CONCLUSION GPA conferred incremental benefit when performed in addition to re-PVI in patients with PAF recurrence; the GPA group yielded higher success rates than the re-PVI group.
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Affiliation(s)
- Feng-Qiang Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Department of Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jun-Jie Guo
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Y I An
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - DE-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin DU
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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30
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Abstract
Ganglionated plexi (GP), consisting of conglomerations of autonomic ganglia on the epicardial surface of the heart, have been shown to play a significant role in different arrhythmias, including atrial fibrillation. GP ablation has become an adjunctive procedure in the treatment of atrial fibrillation, while it has been used successfully in preliminary studies in vasovagal syncope. This review will present the current data on the physiology and clinical applications of GP ablation in the treatment of atrial fibrillation and other diseases.
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Affiliation(s)
- Stavros Stavrakis
- University of Oklahoma Health Sciences Center,Oklahoma City, Oklahoma, USA
| | - Sunny Po
- University of Oklahoma Health Sciences Center,Oklahoma City, Oklahoma, USA
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31
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Kocyigit D, Canpolat U, Aytemir K. Who Needs Catheter Ablation And Which Approach? J Atr Fibrillation 2016; 8:1335. [PMID: 27957233 DOI: 10.4022/jafib.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
Abstract
Catheter ablation therapy for atrial fibrillation (AF) has gained a significant role during maintenance of sinus rhythm compared to anti-arrhythmic medication. Catheter ablation techniques are also improved and progressed over years in parallel to better understanding of disease mechanisms and technological advancements. However, due to invasive nature of the therapy with its pertinent procedural risks, both appropriate patient selection and use of relevant approach should be considered by all electrophysiologists before decide to perform catheter ablation.
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Affiliation(s)
- Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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32
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Relationship Between Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence. JACC Clin Electrophysiol 2016; 2:474-483. [DOI: 10.1016/j.jacep.2016.02.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 12/17/2022]
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DEKKER LUKASRC, POKUSHALOV EVGENY, SANDERS PRASHANTHAN, LINDBORG KATHERINEA, MAUS BÄRBEL, PÜRERFELLNER HELMUT. Continuous Cardiac Monitoring around Atrial Fibrillation Ablation: Insights on Clinical Classifications and End Points. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:805-13. [DOI: 10.1111/pace.12897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- LUKAS RC DEKKER
- Department of Cardiology; Catharina Hospital; Eindhoven The Netherlands
| | - EVGENY POKUSHALOV
- Arrhythmia Department; State Research Institute of Circulation Pathology; Novosibirsk Russia
| | - PRASHANTHAN SANDERS
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute; University of Adelaide and Royal Adelaide Hospital; Adelaide Australia
| | | | - BÄRBEL MAUS
- Medtronic Bakken Research Center; Maastricht The Netherlands
| | - HELMUT PÜRERFELLNER
- Department of Cardiology; Elisabethinen University Teaching Hospital; Linz Austria
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34
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Sticherling C. Pulmonary vein isolation: Is our target the one we think? Heart Rhythm 2016; 13:1858-9. [PMID: 27311720 DOI: 10.1016/j.hrthm.2016.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Indexed: 11/18/2022]
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35
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Choi EK, Chen PS. Is the Atrial Neural Plexis a Therapeutic Target in Atrial Fibrillation? Methodist Debakey Cardiovasc J 2016; 11:82-6. [PMID: 26306124 DOI: 10.14797/mdcj-11-2-82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Circumferential pulmonary vein isolation is the mainstay of atrial fibrillation (AF) ablation, but alternative approaches and techniques have been developed to improve the outcomes. One of these additional ablation targets are ganglionated plexi of the intrinsic cardiac autonomic system that contain a variety of sympathetic and parasympathetic neurons that communicate with the extrinsic cardiac autonomic nervous system. The ganglionated plexi of the heart do not serve as a simple relay station but could modulate the autonomic interaction between the extrinsic and intrinsic cardiac autonomic system. Intrinsic cardiac autonomic nerve activity is an invariable trigger of paroxysmal atrial tachyarrhythmia, including atrial fibrillation. Although multiple studies have shown that ganglionated plexi play an important role in initiating atrial fibrillation, there is no consensus on a standardized protocol for selecting target sites and determining how ganglionated plexi ablation can best be accomplished. Recent clinical trials have demonstrated the feasibility and efficacy of ganglionated plexi ablation in addition to pulmonary vein isolation, but novel technologies and strategies are necessary to improve the current ablation techniques in managing patients with atrial fibrillation. This review focuses on the relationship between atrial ganglionated plexi and atrial fibrillation and the potential benefits and limitations of ganglionated plexi ablation in the management of atrial fibrillation.
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Affiliation(s)
- Eue-Keun Choi
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Peng-Sheng Chen
- Indiana University School of Medicine, Indianapolis, Indiana
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Gerstenfeld EP, Duggirala S. Atrial Fibrillation Ablation: Indications, Emerging Techniques, and Follow-Up. Prog Cardiovasc Dis 2015; 58:202-12. [DOI: 10.1016/j.pcad.2015.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhang M, Wang X, Xie X, Wang Z, Liu X, Guan J, Wang W, Li Z, Wang J, Gao M, Hou Y. Long-Term Effects of Atrial Ganglionated Plexi Ablation on Function and Structure of Sinoatrial and Atrioventricular Node in Canine. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1181-91. [PMID: 26172918 DOI: 10.1111/pace.12689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/19/2015] [Accepted: 06/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term effects of ganglionated plexi (GP) ablation on sinoatrial node (SAN) and atrioventricular node (AVN) remain unclear. This study is to investigate the long-term effects of ablation of cardiac anterior right GP (ARGP) and inferior right GP (IRGP) on function and structure of SAN and AVN in canine. METHODS Thirty-two dogs were randomly divided into an operated group (n = 24) and sham-operated group (n = 8). ARGP and IRGP were ablated in operated group which was randomly divided into three subgroups according to the period of evaluation after operation (1 month, 6 months, 12 months). The functional and histological characteristics of SAN and AVN, as well as the expression of connexin (Cx) 43 and Cx 45 in SAN and AVN, were evaluated before and after ablation. RESULTS Resting heart rate was increased and AVN effective refractory period was prolonged and sinus node recovery time (SNRT) and corrected SNRT were shortened immediately after ablation. These changes were reverted to preablation level after 1 month. At 1 month, ventricular rate during atrial fibrillation was slowed, atria-His intervals were prolonged, and Cx43 and Cx45 expression in SAN and AVN were downregulated. At 6 months, all changes were reverted to preablation level. The histological characteristics of SAN and AVN did not change. CONCLUSION Ablation of ARGP and IRGP has short-term effects on function and structure of SAN and AVN rather than long-term effects, which suggests that ablation of ARGP and IRGP is safe. Atrioventricular conduction dysfunction after ablation may be related to downregulated Cx43 and Cx45 expression in AVN.
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Affiliation(s)
- Ming Zhang
- Department of Intensive Care Unit, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ximin Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xinxing Xie
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhongsu Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xiaoyan Liu
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Juan Guan
- Department of Pharmacology, Shandong University School of Medicine, Jinan, China
| | - Weizong Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhan Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jiangrong Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Mei Gao
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Wang X, Zhang M, Zhang Y, Xie X, Wang W, Li Z, Gao M, Wang Z, Hou Y. Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and Neuron Remodeling in Target Atrial Tissues in a Canine Model. Circ Arrhythm Electrophysiol 2015; 8:1276-83. [PMID: 26078277 DOI: 10.1161/circep.114.002554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The long-term effects of ganglionated plexi ablation on electrophysiological characteristics and neuron remodeling in target atrial tissues remain unclear. METHODS AND RESULTS Dogs in group 1 (control, n=8) were not subjected to ganglionated plexi ablation and observed for 1 month, and dogs in groups 2 to 4 (ablation groups, n=8 each) underwent ablation of the right-sided ganglionated plexi and observed for 1, 6, and 12 months, respectively. Atrial electrophysiological characteristics were examined before ablation, immediately and continuously after ablation. Target atrial tissues were subjected to immunohistochemical staining and Western blot analysis. Atrial effective refractory period was significantly prolonged immediately after ablation (P<0.001), and persisted for 1 month (P<0.05). Nerve densities decreased 1 month after ablation (P<0.001). These parameters reverted to preablation levels after 6 and 12 months. In the ablation groups, atrial fibrillation was induced in 5 of 8 dogs after 1 month and in all animals after 6 and 12 months. Atrial fibrillation was not observed in the control group and in the experimental groups immediately after ablation. Moreover, the expression of the growth-associated protein 43 was upregulated after ablation. CONCLUSIONS Ganglionated plexi ablation effectively prolonged atrial effective refractory period for a short period, but the long-term effects on atrial effective refractory period and the suppression of atrial fibrillation induction were not persistent. Targeted atrial neuron remodeling may be an important mechanism underlying the observed electrophysiological changes.
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Affiliation(s)
- Ximin Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ming Zhang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yujiao Zhang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xinxing Xie
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Weizong Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhan Li
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Mei Gao
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhongsu Wang
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yinglong Hou
- From the School of Medicine (X.W., Y.Z., W.W., Z.L.), Departments of Cardiology (X.X., M.G., Z.W., Y.H.), and Intensive Care Unit (M.Z.), Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
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Stavrakis S, Nakagawa H, Po SS, Scherlag BJ, Lazzara R, Jackman WM. The role of the autonomic ganglia in atrial fibrillation. JACC Clin Electrophysiol 2015; 1:1-13. [PMID: 26301262 DOI: 10.1016/j.jacep.2015.01.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent experimental and clinical studies have shown that the epicardial autonomic ganglia play an important role in the initiation and maintenance of atrial fibrillation (AF). In this review, we present the current data on the role of the autonomic ganglia in the pathogenesis of AF and discuss potential therapeutic implications. Experimental studies have demonstrated that acute autonomic remodeling may play a crucial role in AF maintenance in the very early stages. The benefit of adding ablation of the autonomic ganglia to the standard pulmonary vein (PV) isolation procedure for patients with paroxysmal AF is supported by both experimental and clinical data. The interruption of axons from these hyperactive autonomic ganglia to the PV myocardial sleeves may be an important factor in the success of PV isolation procedures. The vagus nerve exerts an inhibitory control over the autonomic ganglia and attenuation or loss of this control may allow these ganglia to become hyperactive. Autonomic neuromodulation using low-level vagus nerve stimulation inhibits the activity of the autonomic ganglia and reverses acute electrical atrial remodeling during rapid atrial pacing and may provide an alternative non-ablative approach for the treatment of AF, especially in the early stages. This notion is supported by a preliminary human study. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Benjamin J Scherlag
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ralph Lazzara
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Park J, Pak HN. Elimination Of Triggers Without An Additional Substrate Modification Is Not Sufficient In Patients With Persistent Atrial Fibrillation. J Atr Fibrillation 2015; 7:1207. [PMID: 27957155 DOI: 10.4022/jafib.1207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a multifactorial disease with complex pathophysiology. Although restoring sinus rhythm delays the progression of atrial remodeling, non-pharmacologic intervention, such as radiofrequency catheter ablation (RFCA), should be done based on the background pathophysiology of the disease. While circumferential pulmonary vein isolation (CPVI) has been known to be the cornerstone of AF catheter ablation, a clinical recurrence rate after CPVI is high in patients with persistent AF (PeAF). Step-wise linear ablation, complex fractionate atrial electrogram (CFAE)-guided ablation, rotor ablation, ganglionate plexus ablation, and left atrial appendage isolation may improve the ablation success rate after CPVI. But, there are still substantial AF recurrences after such liberal atrial substrate ablation, and current ablation techniques regarding substrate modification still have limitations. Therefore, more understanding about AF pathophysiology and early precise intervention may improve clinical outcome of AF management. Keeping in mind "more touch, more scar," operators should generate most efficient substrate modification to achieve better long-term clinical outcome.
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Affiliation(s)
- Junbeom Park
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
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Kurotobi T, Shimada Y, Kino N, Ito K, Tonomura D, Yano K, Tanaka C, Yoshida M, Tsuchida T, Fukumoto H. Features of intrinsic ganglionated plexi in both atria after extensive pulmonary isolation and their clinical significance after catheter ablation in patients with atrial fibrillation. Heart Rhythm 2014; 12:470-476. [PMID: 25433142 DOI: 10.1016/j.hrthm.2014.11.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The features of intrinsic ganglionated plexi (GP) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF). OBJECTIVE The purpose of this study was to assess the features of GP response after extensive PVI and to evaluate the relationship between GP responses and subsequent AF episodes. METHODS The study population consisted of 216 consecutive AF patients (104 persistent AF) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI. RESULTS GP responses were determined in 186 of 216 patients (85.6%). In the left atrium, GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%) and around the left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area: inside the CS in 64 of 216 patients (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (hazard ratio 4.04, confidence interval 1.48-11.0) in patients with paroxysmal, but not persistent, AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% vs 8% in those without a GP response (P = .002). CONCLUSION The presence of GP responses after extensive PVI was significantly associated with increased AF recurrence after ablation in patients with paroxysmal AF.
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Affiliation(s)
| | | | - Naoto Kino
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | - Kazato Ito
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | | | - Kentaro Yano
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | - Chiharu Tanaka
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
| | | | - Takao Tsuchida
- Cardiovascular Division, Shiroyama Hospital, Osaka, Japan
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Katritsis GD, Katritsis DG. Cardiac Autonomic Denervation for Ablation of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2014; 3:113-5. [PMID: 26835076 DOI: 10.15420/aer.2014.3.2.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/21/2014] [Indexed: 11/04/2022] Open
Abstract
The influence of the autonomic nervous system (ANS) on triggering and perpetuation of atrial fibrillation (AF) is well established. Ganglionated plexi (GP) ablation achieves autonomic denervation by affecting both the parasympathetic and sympathetic components of the ANS. GP ablation can be accomplished endocardially or epicardially, i.e. during the maze procedure or thoracoscopic approaches. Recent evidence indicates that anatomic GP ablation at relevant atrial sites appears to be safe and improves the results of pulmonary vein isolation in patients with paroxysmal and persistent AF.
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Affiliation(s)
- George D Katritsis
- Academic Foundation Trainee, John Radcliffe Hospital, The Oxford University Clinical Academic Graduate School, Oxford, UK
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Kosiuk Md J, Pokushalov Md Phd E, Hilbert Md S, Hindricks Md G, Bollmann Md PhD A, S Steinberg Md J. The Role of Renal Sympathetic Denervation in Atrial Fibrillation. J Atr Fibrillation 2014; 6:987. [PMID: 27957040 DOI: 10.4022/jafib.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 11/10/2022]
Abstract
Endocardial catheter ablation is a widely used alternative for the treatment of atrial fibrillation (AF). Despite technical improvements, and increased understanding of mechanism, and acquired technical experience over many years, the results are not yet optimal. This results in an ongoing search for new therapeutic approaches. Because cardiac sympathetic drive is potentially responsible for triggering and sustaining AF, modulation of sympathetic tone has been proposed as a viable treatment objective. The early attempts to test this concept were limited by nature=highly intrusive techniques but new approaches and targets have been recently introduced. Specifically, renal nerve ablation has been introduced and the first attempts to employ this technique for treatment of cardiac arrhythmias give as a promise of new therapeutic avenues in near future. This review focuses on the possible role of renal denervation in treatment of atrial fibrillation, the contemporary evidence supporting this approach, and the ongoing trials to establish its therapeutic role.
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Affiliation(s)
- Jedrzej Kosiuk Md
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | | | | | | | | | - Jonathan S Steinberg Md
- Arrhythmia Institute, The Valley Health System and the Mt. Sinai School of Medicine, New York, NY, USA
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Seaborn GEJ, Todd K, Michael KA, Baranchuk A, Abdollah H, Simpson CS, Akl SG, Redfearn DP. Heart rate variability and procedural outcome in catheter ablation for atrial fibrillation. Ann Noninvasive Electrocardiol 2013; 19:23-33. [PMID: 24112475 DOI: 10.1111/anec.12098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In patients with normal hearts, increased vagal tone is associated with onset of paroxysmal atrial fibrillation (AF). Vagal denervation of the atria renders AF less inducible. Circumferential pulmonary vein isolation (CPVI) is effective for treating paroxysmal and persistent AF, and has been shown to impact heart rate variability (HRV) indices, in turn, reflecting vagal denervation. We examined the impact of CPVI on HRV indices, and evaluated the relationship between vagal modification and AF recurrence. METHODS Electrocardiogram recordings were collected from 83 consecutive patients (63 male, 20 female, age 56.9 ± 9.3 years) undergoing CPVI for paroxysmal (n = 56) or persistent (n = 27) AF. Recordings were obtained over 10 minutes preprocedure, and at intervals up to 12 months. Antiarrhythmic medications were suspended prior to CPVI, and were resumed for 3 months following. Success was defined as no recurrence of atrial arrhythmia lasting longer than 30 seconds. RESULTS In patients with successful procedures (n = 56, 42 paroxysmal, 14 persistent), HRV indices were significantly altered, with respect to preprocedure levels, over a sustained period. However, patients with recurrence (n = 27, 14 paroxysmal, 13 persistent) demonstrated similar HRV to their preprocedure levels over the follow-up period. CONCLUSION Our results suggest that patients experiencing recurrence after a single CPVI have HRV attenuated by the procedure only intermittently, whereas patients with one successful CPVI experience a sustained change. A short-term HRV recording is a convenient and potentially important marker for recurrence of atrial arrhythmia in a population undergoing CPVI.
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Affiliation(s)
- Geoffrey E J Seaborn
- Division of Cardiology (Arrhythmia Service), Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Katritsis DG, Pokushalov E, Romanov A, Giazitzoglou E, Siontis GCM, Po SS, Camm AJ, Ioannidis JPA. Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: a randomized clinical trial. J Am Coll Cardiol 2013; 62:2318-25. [PMID: 23973694 DOI: 10.1016/j.jacc.2013.06.053] [Citation(s) in RCA: 295] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/27/2013] [Accepted: 06/02/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). BACKGROUND Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. METHODS A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. RESULTS Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered. CONCLUSIONS Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.
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Affiliation(s)
| | - Evgeny Pokushalov
- Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Alexander Romanov
- Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - George C M Siontis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - A John Camm
- Cardiac and Vascular Sciences, St. George's, University of London, London, United Kingdom
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford University School of Medicine, and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
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Chugh A. Ganglionated plexus ablation in patients undergoing pulmonary vein isolation for paroxysmal atrial fibrillation: here we go again. J Am Coll Cardiol 2013; 62:2326-8. [PMID: 23973692 DOI: 10.1016/j.jacc.2013.07.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Aman Chugh
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan.
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47
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Kondo Y, Ueda M, Watanabe M, Ishimura M, Kajiyama T, Hashiguchi N, Kanaeda T, Nakano M, Hiranuma Y, Ishizaka T, Matsumiya G, Kobayashi Y. Identification of left atrial ganglionated plexi by dense epicardial mapping as ablation targets for the treatment of concomitant atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1336-41. [PMID: 23742214 PMCID: PMC4285812 DOI: 10.1111/pace.12169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/06/2013] [Accepted: 03/17/2013] [Indexed: 11/29/2022]
Abstract
Background Autonomic ganglionated plexi (GPs) play a significant role in the initiation and maintenance of atrial fibrillation (AF). GPs are key targets for a maze procedure. The purpose of this study was to identify the location of the left atrial GPs based on dense epicardial mapping during a maze procedure in patients with concomitant AF. Methods Sixteen patients (age, 68 ± 10 years; 11 males, 69%) with heart failure and concomitant AF (duration 55 ± 86 months) underwent intraoperative epicardial electrophysiological mapping and a GP ablation using the maze procedure at our institution. Twenty-four-site, high-frequency stimulation (1,000/min; output, 18 V; pulse width, 0.75 ms) was performed by placing tweezers directly onto the potential GP sites on the left atrial epicardium. Results Active GPs were found in 13 (81%) of the 16 patients, and 12 (92%) of 13 patients had active GPs between the right pulmonary veins (PVs) and the interatrial groove. For those patients with active locations, a 7-day event-loop recording demonstrated that 12 (92%) of 13 patients were maintained in sinus rhythm 3 months after the operation. Conclusion Dense epicardial mapping in the potential GP areas identified active GP locations in a high percentage of patients. GPs between the PVs and interatrial groove have a high potential as ablation targets for treatment of concomitant AF.
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Pokushalov E, Romanov A, Katritsis DG, Artyomenko S, Shirokova N, Karaskov A, Mittal S, Steinberg JS. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison. Heart Rhythm 2013; 10:1280-6. [PMID: 23608592 DOI: 10.1016/j.hrthm.2013.04.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optimal ablation technique for persistent and long-standing persistent atrial fibrillation (AF) is unclear. Both linear lesion (LL) and ganglionated plexus (GP) ablation have been used in addition to pulmonary vein isolation (PVI), but no direct comparison of the 2 methods exists. OBJECTIVE The aim of this study is to assess the comparative safety and efficacy of 2 different ablation strategies-PVI+LL vs PVI+GP ablation -in patients with persistent or long-standing persistent AF. METHODS Two hundred sixty-four consecutive patients with persistent/long-standing persistent AF were randomly assigned to 2 different ablation schemes: PVI+LL (n = 132) and PVI+GP (n = 132) ablation. Consistent sinus rhythm (SR) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device. RESULTS All procedural end points were acutely achieved. At 12 months after a single procedure, 47% of the patients treated with PVI+LL were in SR compared to 54% of the patients treated with PVI+GP (P = .29). At 3 years, 34% of the patients with PVI+LL and 49% of the patients with PVI+GP maintained SR (P = .035). Atrial flutter was more frequent in the PVI+LL group than in PVI+GP group (18% vs 6%; P = .002). After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group, the long-term overall success rate was 52% and 68%, respectively (P = .006). CONCLUSIONS PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL ablation at 3 years of follow-up.
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Affiliation(s)
- Evgeny Pokushalov
- Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
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Mathew S, Metzner A, Ouyang F, Kuck KH, Tilz RR. [Catheter ablation of paroxysmal atrial fibrillation. Optimal approach and result]. Herzschrittmacherther Elektrophysiol 2013; 24:7-14. [PMID: 23588966 DOI: 10.1007/s00399-013-0244-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/29/2013] [Indexed: 11/28/2022]
Abstract
The gold standard in ablation of paroxysmal atrial fibrillation (PAF) is radiofrequency (RF) based point by point pulmonary vein isolation (PVI). In the majority of patients with PAF (80 %) PVI can restore stable SR even during long-term follow-up of up to 5 years. However multiple procedures are often required. Cryo-balloon based PVI is an established technique. Safety and efficacy are comparable to RF ablation. Due to the high success rates in patients with PAF and the progression rate to persistent atrial fibrillation (AF) an early intervention is recommended as implemented in the latest guidelines for AF treatment.
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Affiliation(s)
- Shibu Mathew
- II. Medizinische Klinik, Klinik für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, Hamburg, Germany.
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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