Selective ganglionated plexi ablation for paroxysmal atrial fibrillation
| Autor: | Evgeny Pokushalov, Pavel Shugayev, Sergey Artyomenko, Alexander Romanov, Natalya Shirokova, Alex Turov, Demosthenes G. Katritsis |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Stimulation Catheter ablation Vagotomy Physiology (medical) Internal medicine Atrial Fibrillation Heart Septum medicine Humans Autonomic Pathways Heart Atria business.industry Vagus Nerve Atrial fibrillation Middle Aged Ablation medicine.disease Heart septum Vagus nerve Blood pressure Anesthesia Catheter Ablation Cardiology Female Cardiology and Cardiovascular Medicine business Tomography Spiral Computed |
| Zdroj: | Heart Rhythm. 6:1257-1264 |
| ISSN: | 1547-5271 |
| Popis: | Background Selective ganglionated plexi (GP) ablation guided by high-frequency stimulation has been proposed for the treatment of paroxysmal atrial fibrillation (AF), but the efficacy of the method is not established. Objective This study sought to compare selective ablation of GP identified by high-frequency stimulation with extensive regional ablation targeting the anatomic areas of GP in patients with paroxysmal AF. Methods Eighty patients with paroxysmal AF (age 53 ± 9 years) were randomized to undergo selective GP ablation or regional left atrial ablation at the anatomic sites of GP. For selective GP ablation (n = 40), ablation targets were the sites where vagal reflexes were evoked by high-frequency stimulation. Vagal reflexes were defined as prolongation of the R-R interval by >50% and a concomitant decrease in blood pressure (>20 mm Hg) during AF. The end point of the procedure was failure to reproduce vagal reflexes with repeated high-frequency stimulation. For anatomic ablation, lesions were delivered at the sites of GP clustering. Results At 13.1 ± 1.9 months, 42.5% of patients with selective GP and 77.5% of patients with anatomic ablation were free of symptomatic paroxysmal AF (PAF) ( P = .02). Parasympathetic denervation was more prominent in patients with anatomic than selective GP ablation, and in patients free of AF compared to these with AF recurrence immediately after ablation, but this trend was abolished at 6 months. Conclusion Selective GP ablation directed by high-frequency stimulation does not eliminate paroxysmal AF in the majority of patients. An anatomic approach for regional ablation at the sites of GP confers better results. |
| Databáze: | OpenAIRE |
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