Pulmonary vein isolation with adjunctive left atrial ganglionic plexus ablation for treatment of atrial fibrillation: a meta-analysis of randomized controlled trials

Rackley, Justin; Nudy, Matthew; González, Mario D.; Naccarelli, Gerald V.; Maheshwari, Ankit

doi:10.1007/s10840-022-01212-1

Cited by 13 publications

(5 citation statements)

References 46 publications

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“…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 ]. Lately, Li et al showed that the vein of Marshall ethanol infusion decreased atrial tachyarrhythmia recurrence compared to PVI alone, especially when substrate ablation was also performed [ 50 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 73%

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

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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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.

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Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 73%

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

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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“…A systematic meta-analysis demonstrates that the addition of GP ablation is associated with increased rates of freedom from AT/AF in patients with paroxysmal AF ( 76 ). And another meta-analysis also shows a significant reduction in AF recurrence when GP ablation is added to PVI compared with PVI alone ( 77 ). However, few study showed that GP ablation did not result in additional benefits in patients with a large left atrium, persistent AF and/or a history of prior catheter ablation ( 78 ).…”

Section: Neuromodulation Methods For Afmentioning

confidence: 99%

Development of neuromodulation for atrial fibrillation: a narrative review

Yang,

Zou,

Wen

et al. 2024

J Thorac Dis

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Background and Objective Atrial fibrillation (AF) is a prevalent clinical arrhythmia with a high incidence of disability and mortality. Autonomic nervous system (ANS) plays a crucial role in the onset and persistence of AF, and can lead to electrophysiological changes and alterations in atrial structure. Both animal models and clinical findings suggest that parasympathetic and sympathetic activity within the cardiac ANS could induce atrial remodeling and AF. Remodeling of the cardiac autonomic nerves is a significant structural basis for promoting AF. Given the challenges faced by conventional pharmacological and atrial ablation techniques in the treatment of AF, increasing attention has been paid to autonomic intervention strategies for AF. Current research has demonstrated that the frequency and severity of AF episodes can be significantly reduced by modulating the activity of ANS. ANS neuromodulation is expected to lead more effective and personalized treatment options for patients with AF. The objective of this review is to provide a broader perspective for future related studies by reviewing preclinical and clinical studies of neuromodulation methods for the treatment of AF, searching for relevant approaches to treat AF, as well as identifying the strengths and weaknesses demonstrated by current relevant studies, and providing researchers with a broader overview of the latest neurological treatments for AF. Methods A narrative review was conducted on the literature on PubMed, WanFang data, and Google Scholar, including all relevant studies published until November 2023. Key Content and Findings In this review, we delve into the innervation of cardiac autonomic nerves, the role of the ANS in the development and maintenance of AF, and the current neuromodulation methods for AF treatment. These methods include stellate ganglion (SG) resection or ablation, vagus nerve stimulation (VNS), thoracic subcutaneous nerve stimulation (ScNS), renal denervation (RDN) therapy, ganglionated plexus (GP) ablation, and epicardial botulinum toxin or CaCl 2 injection. More and more research suggests that neuromodulation methods for the treatment of AF have broad prospects. Conclusions ANS plays a crucial role in AF development and maintenance through cardiac autonomic nerve remodeling. Modulating ANS activity can significantly reduce AF frequency and severity, offering more personalized treatment options. Current research on autonomic interventions for AF shows promise for more effective and personalized treatments.

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“…Several clinical trials, including randomized ones, tested this hypothesis and showed that GP modulation on top of PVI led to a significant decrease in AF recurrences in patients with both paroxysmal and persistent AF undergoing endocardial ablation [150,151]. Nonetheless, pooled analysis including a recent meta-analysis including only randomized control trials (RCTs) highlighted how the adjunctive effect of GPs modulation is greater in paroxysmal AF and inversely correlates with the left atrium diameter [152]. However, GP ablation alone was not superior to PVI [153].…”

Section: Icns Modulation In Atrial Fibrillationmentioning

confidence: 99%

The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications

Giannino,

Braia,

Griffith Brookles

et al. 2024

Biology

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The cardiac autonomic nervous system (CANS) plays a pivotal role in cardiac homeostasis as well as in cardiac pathology. The first level of cardiac autonomic control, the intrinsic cardiac nervous system (ICNS), is located within the epicardial fat pads and is physically organized in ganglionated plexi (GPs). The ICNS system does not only contain parasympathetic cardiac efferent neurons, as long believed, but also afferent neurons and local circuit neurons. Thanks to its high degree of connectivity, combined with neuronal plasticity and memory capacity, the ICNS allows for a beat-to-beat control of all cardiac functions and responses as well as integration with extracardiac and higher centers for longer-term cardiovascular reflexes. The present review provides a detailed overview of the current knowledge of the bidirectional connection between the ICNS and the most studied cardiac pathologies/conditions (myocardial infarction, heart failure, arrhythmias and heart transplant) and the potential therapeutic implications. Indeed, GP modulation with efferent activity inhibition, differently achieved, has been studied for atrial fibrillation and functional bradyarrhythmias, while GP modulation with efferent activity stimulation has been evaluated for myocardial infarction, heart failure and ventricular arrhythmias. Electrical therapy has the unique potential to allow for both kinds of ICNS modulation while preserving the anatomical integrity of the system.

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Pulmonary vein isolation with adjunctive left atrial ganglionic plexus ablation for treatment of atrial fibrillation: a meta-analysis of randomized controlled trials

Cited by 13 publications

References 46 publications

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

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

Development of neuromodulation for atrial fibrillation: a narrative review

The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications

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