Vagal responses induced by endocardial left atrial autonomic ganglion stimulation before and after pulmonary vein antrum isolation for atrial fibrillation

Verma, Atul; Saliba, Walid; Lakkireddy, Dhanumjaya; Burkhardt, J. David; Cummings, Jennifer E.; Wazni, Oussama; Belden, William; Thal, Sergio; Schweikert, Robert A.; Martin, David O.; Tchou, Patrick; Natale, Andrea

doi:10.1016/j.hrthm.2007.04.023

Cited by 66 publications

(55 citation statements)

References 15 publications

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“…The findings of these studies were consistent with the anatomical findings reported by Armour, et al 1) Our findings are consistent with previous reports that a vagal response was induced by high-frequency stimulation from the upper part of the superior PVs and lower part of the inferior PVs. In our study, the Lasso catheter seemed to be closer to the PV orifices than in previous studies; [11][12][13][16][17][18] however, Tan, et al 19) and Matsuyama,et al 20) reported that autonomic nerves were located within 5 mm of each PV-left atrial junction. A vagal response was also noted during catheter ablation at the similar part of the PVs at which highfrequency stimulation evoked the vagal response.…”

Section: Discussioncontrasting

confidence: 55%

“…Localizing GP sites for ablation: Previous studies have shown the feasibility of cardiac GP stimulation by evoking a vagal response using high-frequency stimulation from a steerable ablation catheter. [11][12][13][16][17][18] Vagal response sites are usually located at least 1-2 cm outside the PV ostia. The anterior right GP is located anterior to the RSPV; the inferior right GP is located inferior to the LIPV; the inferior left GP is located inferior to the LIPV, and the superior left GP is located superior to the LSPV.…”

Section: Discussionmentioning

confidence: 99%

“…Relation of GP ablation to outcome: Catheter ablation of GP has been shown to prevent vagal AF in canine models. 8,11,21) In recent clinical studies, vagal denervation was induced by targeted GP ablation 9,11,13,17) or inadvertently by standard circumferential or segmental PVI. 16,22) However, only limited data have been available on the long-term benefit of vagal denervation.…”

Section: Discussionmentioning

confidence: 99%

“…However, this decrease is only transient with segmental PV ablation, but it persists for at least 1 year with circumferential PV ablation. 16) Verma, et al 17) reported that standard PV antrum isolation eliminates vagal responses induced by GP stimulation. Responses were not seen in any of the 20 patients undergoing repeat PV antrum isolation, despite clinical recurrence of AF in 19 of the 20 patients at 4 ± 2 months after the initial ablation procedure.…”

Section: )mentioning

confidence: 99%

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Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation

et al. 2008

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SUMMARYThis study was designed to determine whether endocardial high-frequency stimulation at the pulmonary vein (PV) antrums can localize cardiac autonomic ganglionated plexi (GP) and whether ablation at these sites can evoke a vagal response and provide a longterm benefit after PV isolation (PVI) for atrial fibrillation (AF).Radiofrequency ablation of each PV antrum was performed in 21 patients with paroxysmal AF (n = 17) or persistent (n = 4) AF. In 8 patients with paroxysmal AF, a ring electrode catheter was placed at each PV antrum. High-frequency stimulation prolonged the R-R interval in 6 of 8 patients at the left superior (LS) PV, in 3 of 8 patients at the left inferior (LI) PV, in 3 of 8 patients at the right superior (RS) PV, and in 3 of 8 patients at the right inferior (RI) PV. A decrease in sinus rate > 20% was observed in 4 of 21 patients during LS PVI, in 2 of 21 patients during RS PVI, and in 1 of 2 patients during RI PVI. Atrioventricular block or a > 5 second pause was observed in 5 of 21 patients during LS PVI. AF recurred during the follow-up period in 5 of the 16 patients (31%) who had no atrioventricular block or > 5 second pause during PVI but did not recur in 5 patients in whom atrioventricular block or a > 5 second pause developed during PVI.GP can be identified by endocardial stimulation. The AF recurrence rate is decreased when a vagal response is achieved by radiofrequency ablation. (Int Heart J 2008; 49: 661-670) Key words: Paroxysmal atrial fibrillation, Pulmonary vein isolation, Cardiac autonomic nerve denervation, Catheter ablation A description of the intrinsic cardiac nervous system in humans by Armour, et al 1) raised the question of whether autonomic inputs from the ganglionated plexiFrom the Divisions of Cardiology,

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: )mentioning

confidence: 99%

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Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation

et al. 2008

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“…However, the results of this strategy have been mixed. [73][74][75][76][77][78][79] Choi et al recently demonstrated that in ambulatory dogs, all episodes of atrial tachyarrhythmias were preceded by bursts of autonomic activity (both parasympathetic and sympathetic), 6 suggesting that vagal activity alone may not explain arrhythmogenesis in the atria. Additionally, intracardiac ganglia not only provide some parasympathetic and sympathetic efferent innervation of the atria, they also process afferent information as well.…”

Section: Vagal Stimulation Vagal Stimulation and Atrial Electrophysiomentioning

confidence: 99%

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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The interplay between the central nervous system and cardiac electrophysiology is fundamental, and becomes obvious each time one's pulse quickens in response to stress. Normally, cardiac neurohormonal regulation is accomplished through the balanced effects of sympathetic and parasympathetic autonomic stimulation, along with the hormonal regulation of the renin-angiotensinaldosterone system (RAAS). Autonomic and hormonal input modulate multiple facets of cellular electrophysiology -action potential duration, ion channel kinetics and intracellular calcium dynamics (just to name a few) -which translate into macroscopic manifestations of autonomic modulation such as heart rate variability, atrioventricular (AV) conduction time and QT interval variability.1 Therefore, it is no surprise that neurohormonal regulation of cardiac electrophysiology is an area of active investigation for its potential antiarrhythmic effects. Recent reviews have focused on the efficacy of neurohormonal modulation, via non-pharmacological methods, to enhance heart failure treatment. 2,3 This review will attempt to provide a state-of-the-art on the potential antiarrhythmic efficacy of renal artery denervation, spinal cord stimulation and direct vagal stimulation. Neurohormonal Control in the Normal and Failing HeartAutonomic control of cardiac physiology is often conceptualised as parasympathetic (cholinergic) and sympathetic (adrenergic) innervation existing in a 'yin and yang' balance under normal circumstances; however, this concept may be over-simplified. 4 In reality, the intrinsic cardiac nervous system, composed of several ganglia located primarily posterior to the atria, likely acts as a 'little brain' of the heart -it provides efferent input to the myocardium, collects afferent signals on a beat-to-beat basis and performs some integrative functions on its own, all under the tonic modulation of extrinsic sympathetic and parasympathetic input (see Figure 1). 4-8The ganglia are predominantly composed of cholinergic neurons; however, sympathetic efferent neurons are also present. Due to the complex interconnectivity between the ganglia, afferent mechanosensory, nociceptive and chemosensory signals from all four chambers of the heart may be processed within a single ganglion. 4 Such interconnectivity implies that predicting the effect of stimulation or ablation of a particular ganglion may be difficult, because each ganglion performs multiple functions. 7,9Abstract Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension.Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonom...

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Mapping of Persistent Atrial Fibrillation: How Many Sites, How Many Lines?

et al. 2012

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Vagal responses induced by endocardial left atrial autonomic ganglion stimulation before and after pulmonary vein antrum isolation for atrial fibrillation

Cited by 66 publications

References 15 publications

Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation

Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Mapping of Persistent Atrial Fibrillation: How Many Sites, How Many Lines?

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