Intraoperative Epicardial Electrophysiologic Mapping and Isolation of Autonomic Ganglionic Plexi

IntroductionLeft atrial ganglionated plexi ablation is an adjuvant technique used to increase the success rate of surgical ablation of atrial fibrillation. Ganglionated plexi ablation requires previous detection. We aimed to assess determinants of successful ganglionated plexi detection and to correlate range of ganglionated plexi ablation with risk of early atrial fibrillation recurrence.MethodsThe study involved 34 consecutive patients referred for surgical coronary revascularization with concomitant atrial fibrillation ablation. Ganglionated plexi detection was done by inducing vagal reflexes in the area of the pulmonary veins and left atrial fat pads.ResultsDetection of GP was successful in 85% of the patients. There was no difference in preoperative characteristics nor in atrial fibrillation type between patients in whom ganglionated plexi detection was successful and others. The number of detected ganglionated plexi correlated significantly only with preoperative resting heart rate. Significant negative correlation was found in patients with preoperative heart rate>75 beat/min in terms of total number of detected ganglionated plexi (P=0.04). Average number of detected ganglionated plexi was significantly higher in patients with in-hospital atrial fibrillation recurrence requiring electrical cardioversion (3.8±3) in comparison to rest of the study population (2±1.3; P=0.02). In patients in whom 4 or more ganglionated plexi were detected, significantly increased risk of in-hospital atrial fibrillation recurrence was observed (OR 15; 95% CI 1.5-164; P=0.003).ConclusionLeft atrial ganglionated plexi detection was unsuccessful in a considerable percentage of patients. Preoperative heart rate significantly influenced positive ganglionated plexi detection and number of ablated ganglia. Higher number of detected ganglionated plexi was related with early recurrence of atrial fibrillation.

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“…Mehall et al [6] detected 0 to 10 active GP. In their cohort, a mean of 5 GP on the right side and 2.7 GP on the left side were ablated.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Ganglionated Plexi Detection is Related to Heart Rate and Early Recurrence of Atrial Fibrillation after Surgical Ablation

Suwalski¹,

Marczewska²,

Kaczejko³

et al. 2017

Braz J Cardiovasc Surg

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“…High-frequency stimulation at a rate of 800 beats per minute is delivered to the fat pad beside the pulmonary veins and atrial tissue; then a specifi c area with a vagal refl ex (reduction in heart rate) during stimulation is defi ned as an active GP. Mehall et al 34 ablated GPs with a minimally invasive operation for AF. A total of 41 patients with paroxysmal or chronic AF underwent the operation and an average of three active GPs were identifi ed in each patient.…”

Section: Role Of Gp Ablationmentioning

confidence: 98%

Surgery for atrial fibrillation: recent progress and future perspective

Nitta

Ishii

Sakamoto

2012

Gen Thorac Cardiovasc Surg

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Development and introduction of radiofrequency ablation devices allowed the maze procedures to be performed safely and easily, further enabling off-pump pulmonary vein isolation through a mini-thoracotomy or thoracoscope. The effects of the maze procedure include prevention of stroke and other complications related to atrial fibrillation, improved cardiac performance, and relief of symptoms. Indications for the maze procedure have been discussed on the basis of the evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal atrial fibrillation and can be performed with endocardial catheter ablation and minimally invasive epicardial ablation. These two modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability of additional lesions indicated for persistent or long-standing persistent atrial fibrillation, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in recurrence of atrial fibrillation and induction of atrial tachycardia. Intraoperative verification of conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a boxlesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure, but the long-term effect on atrial fibrillation and autonomic nerve activities should be examined.

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“…McClelland et al 61 over a 1 year follow-up, had 14/16 patients showing and overall success rate of 87.5%. Mehall et al 62 using the same techniques found 14 /15 patient free of AF after a short 6 month follow-up. Matsutani et al 63 reported the results of a combined Japan-United States experience using a "thorascopic mini-Maze" procedure for bilateral PVI plus ablation of the epicardial GP.…”

Section: Surgical Reports Combining Pvi and Gp Ablationsmentioning

confidence: 99%

The Autonomic Nervous System and Atrial Fibrillation: The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation

Scherlag¹,

Nakagawa²,

Patterson³

et al. 2009

J.A.F.I.B

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Intraoperative Epicardial Electrophysiologic Mapping and Isolation of Autonomic Ganglionic Plexi

Cited by 95 publications

References 7 publications

Left Atrial Ganglionated Plexi Detection is Related to Heart Rate and Early Recurrence of Atrial Fibrillation after Surgical Ablation

Left Atrial Ganglionated Plexi Detection is Related to Heart Rate and Early Recurrence of Atrial Fibrillation after Surgical Ablation

Surgery for atrial fibrillation: recent progress and future perspective

The Autonomic Nervous System and Atrial Fibrillation: The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation

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