Electrical Stimulation to Identify Neural Elements on the Heart: Their Role in Atrial Fibrillation

Abstract

These basic and clinical studies suggest that localized cardiac autonomic ganglia (GPs) may play a critical role in the initiation and maintenance of AF.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…103,105,114,116,124,355,576,577,578,579,580,581,582 Because the GP are consistently located within areas of highly fractionated atrial potentials (FAPs), also referred to as CFAEs, 103,105,114,116,124,355,576,577,578,579,580,581,582,583,584 it is useful to begin with a fractionation map of the LA and PVs during AF. The LA FAPs are usually located in four areas: (1) LAA ridge FAP area (between LAA and left PVs); (2) superior left FAP area; (3) inferoposterior FAP area; and (4) anterior right FAP area (Figure 4).…”

“…110,121 Stimulation of GP has been shown to elicit AF by producing repetitive bursts of rapid focal PV firing, and ablation of GP can play a role in AF treatment. 257,577,1279 Following ablation of GPs, signs of parasympathetic withdrawal such as increased heart rate and attenuated heart rate variability can be observed, and these signs have been associated with improved procedural outcomes. 118,126,577,1280,1281 Although the increase in heart rate and reduction in heart rate variability after ablation typically follow a transient time course, with resolution within 3 months, some studies have shown that the long-term persistence of these autonomic changes is associated with improved clinical outcomes.…”

“…257,577,1279 Following ablation of GPs, signs of parasympathetic withdrawal such as increased heart rate and attenuated heart rate variability can be observed, and these signs have been associated with improved procedural outcomes. 118,126,577,1280,1281 Although the increase in heart rate and reduction in heart rate variability after ablation typically follow a transient time course, with resolution within 3 months, some studies have shown that the long-term persistence of these autonomic changes is associated with improved clinical outcomes. 126 These clinical data are consistent with experimental findings demonstrating a reduction in stellate ganglion nerve activity and subsequent AF with continuous low-level vagal nerve stimulation.…”

Differences in atrial fibrillation properties under vagal nerve stimulation versus atrial tachycardia remodeling

“…An interesting correlation of CFAEs with DFs and consequently vagal ganglia was also suggested by the electroanatomical mapping performed in our study. Therefore, based also on previous observations 72,73,138,143 , ablation of vagal ganglia during AF ablation could also be advantageous.…”

Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

“…The vagal innervation of the atria is widespread and asymmetrical, and vagal stimulation shortens the refractory period to various extents in different parts of the atrium, thereby increasing the likelihood of AF. 32,33 In certain patients, increased sympathetic tone brings on episodes of AF, and it is likely that sympathovagal balance also plays a role in initiating AF. [34][35][36] ALCOHOL AND CAFFEINE Binge drinking of alcohol has been associated with AF, producing what is called the holiday heart syndrome.…”