Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies.

A case report of cardiac neuromodulation in a young patient with a third-degree atrioventricular block

“…The main locations of the GPs include the following: the superior paraseptal ganglionated plexus (SPSGP, located in the upper area of the right atrium, medial to the outlet of the superior vena cava and lateral to the aortic root) which is the final common pathway of the right vagus that innervates the sinus node; the aorta-superior vena cava ganglionated plexus (Ao-SVC GP), anterior to the previous one; the inferior paraseptal ganglionated plexus (IPSGP, located in the posteroinferior area of the right interatrial septum, near the proximal coronary sinus, and around its ostium) which is the final common pathway of the left vagus that innervates the AV node; the left superior ganglionated plexus (LSGP); the left lateral ganglionated plexus (LLGP), also called GP of Marshall's ligament; right and left inferior ganglionated plexuses (RIGP and LIGP), sometimes identified as oblique sinus GP (OSGP) (1,(5)(6)(7)(8)(9)(10)(11).…”

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

“…Потенциальным преимуществом этой методики в сравнении с традиционными методами (радиочастотной, лазерной аблацией, криоаблацией) является отсутствие серьезных термических повреждений прилежащих структур, прежде всего -пищевода и диафрагмального нерва. В недавно проведенном исследовании изучалось влияние электропорации на длительность ЭРП предсердий в качестве метода повреждения ГС предсердий в хроническом эксперименте [24]. Измерение ЭРП проводилось до и после аблации при стимуляции из области устья коронарного синуса.…”

Epicardial Pulsed Field Ablation of Ganglionated Plexi: Computational and Pre-Clinical Evaluation of a Bipolar Sub-Xiphoid Catheter for the Treatment of Atrial Fibrillation

“…The absence of such damage with endocardial PFA may, in part, explain the ceiling in efficacy outcomes. A technique for epicardial PFA of GPs is currently in development [18]; the safety and feasibility of this approach has already been demonstrated preclinically [19] and clinically [20] in open-chest surgical settings. Figure 1 shows the GP sites targeted in these studies, using two purposedesigned catheters and a pulsed field generator (AtriAN Medical Ltd., Galway, Ireland).…”