Identification of left atrium ganglionated plexi by dense epicardial mapping as ablation targets for the treatment of concomitant atrial fibrillation

Abstract

Purpose: Autonomic ganglionated plexi (GP) have great plasticity in the initiation and maintenance of atrial fibrillation. GP ablation may be an important component for a maze procedure. The purpose of this study was to identify the localization of left atrial GP based on dense epicardial mapping during a maze IV procedure with concomitant AF patients. Methods: Sixteen patients (age, 68±10 years; 11 males, 69%; left atrial diameter, 53±8 mm; and left ventricular ejection fraction, 57±12%) with heart failure and concomitant atrial fibrillation underwent intraoperative epicardial electrophysiological mapping and GP ablation using the maze procedure at our institution. The mean duration of atrial fibrillation was 55±86 months; atrial fibrillation was paroxysmal in 4 patients (25%). Twenty-four site, high-frequency stimulation (1000/min; output, 18 V; pulse width, 0.75 ms) was performed by placing tweezers directly onto the potential GP sites on the left atrial epicardium. Diagram of epicardial mapping locations is shown in the figure. Results: Active GP were found in 13 (81%) of the 16 patients, and all of those patients had active GP between the right pulmonary veins and the interatrial groove. (R6, R10, R12) A 7-day event-loop recording demonstrated that 13 (81%) of the 16 patients were maintained in sinus rhythm 3 months after the operation. For those patients with active GP locations, 12 (92%) out of 13 patients were maintained in sinus rhythm (92%). ![Figure][1] Conclusions: Dense epicardial mapping in the potential GP areas identified active GP locations in a high percentage of patients. GP between the pulmonary veins and the interatrial groove have high potential as ablation targets for treatment of atrial fibrillation. [1]: pending:yes