Ectopy-triggering ganglionated plexuses ablation to prevent atrial fibrillation: GANGLIA-AF study

Kim, Min-young; Coyle, Clare; Tomlinson, David R.; Sikkel, Markus B.; Sohaib, Afzal; Luther, Vishal; Leong, Kevin; Malcolme-Lawes, Louisa; Low, Benjamin E.; Sandler, Belinda; Lim, Elaine; Todd, Michelle; Fudge, Michael; Wright, Ian; Koa‐Wing, Michael; Ng, Fu Siong; Qureshi, Norman; Whinnett, Zachary I.; Peters, Nicholas S.; Newcomb, Daniel; Wood, Cherith; Dhillon, Gurpreet; Hunter, Ross J.; Lim, Phang Boon; Linton, N; Kanagaratnam, Prapa

doi:10.1016/j.hrthm.2021.12.010

Cited by 39 publications

(19 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previously, a prospective, randomized, controlled trial (GANGLIA-AF) targeted specifically the ET-GPs without PVI, and at 12 months’ follow-up, 58% of patients were free of atrial arrhythmias, compared to 64% after PVI. 7 The clinical ET-GP mapping protocol involves delivering HFS from the endocardium, which is presumed to stimulate epicardial GPs that are interconnected with smaller and more downstream nerves in the myocardium and the endocardium. However, from the findings of this study, HFS may be identifying local areas that have a smaller and higher density of nerves, both parasympathetic and sympathetic nerves.…”

Section: Discussionmentioning

confidence: 99%

“… 18 It should also be noted that in the GANGLIA-AF trial, there was a significantly shorter radiofrequency ablation time with ET-GP ablation compared to PVI. 7 This suggests that a wider cloud of ablation at local ET sites may be required to eliminate the more distant GPs, as well as to destroy the smaller, densest part of the intrinsic cardiac nerves to prevent long-term atrial arrhythmia recurrence.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 These results were comparable to the GANGLIA-AF (Ectopy-triggering ganglionated plexuses ablation to prevent atrial fibrillation) trial, where ET-GPs were mapped using HFS and ablated without PVI in patients with paroxysmal AF and showed 58% freedom from atrial arrhythmias at 12 months’ follow-up. 7 However, it is important to note that HFS identifies presumed GP sites by utilizing their functional response to stimulation. There may be unique topological characteristics that are signatures for GP arrhythmogenic response to HFS that are yet to be established.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Immunohistochemical characteristics of local sites that trigger atrial arrhythmias in response to high-frequency stimulation

et al. 2022

Self Cite

View full text Add to dashboard Cite

Aims The response to high frequency stimulation (HFS) is used to locate putative sites of ganglionated plexuses (GPs), which are implicated in triggering atrial fibrillation (AF). To identify topological and immunohistochemical characteristics of presumed GP sites functionally identified by HFS. Methods and results Sixty-three atrial sites were tested with HFS in four Langendorff-perfused porcine hearts. A 3.5 mm tip quadripolar ablation catheter was used to stimulate and deliver HFS to the left and right atrial epicardium, within the local atrial refractory period. Tissue samples from sites triggering atrial ectopy/AF (ET) sites and non-ET sites were stained with choline acetyltransferase (ChAT) and tyrosine hydroxylase (TH), for quantification of parasympathetic and sympathetic nerves, respectively. The average cross-sectional area (CSA) of nerves was also calculated. Histomorphometry of six ET sites (9.5%) identified by HFS evoking at least a single atrial ectopic was compared with non-ET sites. All ET sites contained ChAT-immunoreactive (ChAT-IR) and/or TH-immunoreactive nerves (TH-IR). Nerve density was greater in ET sites compared to non-ET sites (nerves/cm2: 162.3 ± 110.9 vs. 69.65 ± 72.48; P = 0.047). Overall, TH-IR nerves had a larger CSA than ChAT-IR nerves (µm2: 11 196 ± 35 141 vs. 2070 ± 5841; P < 0.0001), but in ET sites, TH-IR nerves were smaller than in non-ET sites (µm2: 6021 ± 14 586 vs. 25 254 ± 61 499; P < 0.001). Conclusions ET sites identified by HFS contained a higher density of smaller nerves than non-ET sites. The majority of these nerves were within the atrial myocardium. This has important clinical implications for devising an effective therapeutic strategy for targeting autonomic triggers of AF.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Immunohistochemical characteristics of local sites that trigger atrial arrhythmias in response to high-frequency stimulation

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Posterior left atrial wall isolation is under investigation in other ongoing clinical trials of AF ablation [ 46 , 47 ], with the results being expected to provide essential information. Regarding other ablation sites, targeting ectopy-triggering ganglionated plexuses was equally effective to PVI in patients with paroxysmal AF, with a trend towards a lower rate of atrial arrhythmia prevention and significantly lower AAD usage after the procedure [ 48 ]. This finding was further supported by a meta-analysis, which showed a lower arrhythmia recurrence (odds ratio (OR) 0.58, 95% CI 0.41–0.82) that was dependent on the left atrial diameter in a meta-regression analysis [ 49 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

View full text Add to dashboard Cite

Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

show abstract

“…STAR AF II assessed whether additional linear ablation and complex fractional electrogram ablation could be used as adjunctive therapy to traditional PVI and found no reduction in the recurrence rate of AF in patients with persistent AF [2]. GANGLIA-AF did not show ablation of gangliated plexuses as superior to PVI in paroxysmal AF patients but did reveal it was effective in hypertensive patients, which is a marker for PVI failure [3]. A sustained reduction in heart rate variability following PVI correlates with a reduction in longterm recurrence of AF which is thought to be secondary to autonomic ganglion injury [4].…”

mentioning

confidence: 99%

The interplay between autonomic tone and atrial arrhythmias

2022

View full text Add to dashboard Cite

Ectopy-triggering ganglionated plexuses ablation to prevent atrial fibrillation: GANGLIA-AF study

Cited by 39 publications

References 20 publications

Immunohistochemical characteristics of local sites that trigger atrial arrhythmias in response to high-frequency stimulation

Immunohistochemical characteristics of local sites that trigger atrial arrhythmias in response to high-frequency stimulation

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

The interplay between autonomic tone and atrial arrhythmias

Contact Info

Product

Resources

About