Stephen Keane, Darshak Patel, Brian Otto, Lily Englander, Ramanan Kumareswaran, David Lin, Michael P. Riley, Saman Nazarian, Francis E. Marchlinski, Timothy M. Markman
{"title":"在心房颤动消融过程中意外消融神经节丛","authors":"Stephen Keane, Darshak Patel, Brian Otto, Lily Englander, Ramanan Kumareswaran, David Lin, Michael P. Riley, Saman Nazarian, Francis E. Marchlinski, Timothy M. Markman","doi":"10.1007/s10840-024-01886-9","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Cardioneuroablation targeting the autonomic nerves within ganglionated plexus (GP) has been used to treat atrial fibrillation (AF). Incidental cardioneuroablation may be an important mechanism by which pulmonary vein isolation (PVI) is effective. Automated fractionation mapping software can identify regions of fractionation correlating with GP locations.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To examine the overlap between standard PVI ablation lesions and fractionated electrograms suggestive of GP.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We retrospectively examined AF ablations performed from 2021 to 2023 that included only PVI performed using wide antral circumferential isolation without prospective evaluation of fractionation. Retrospectively, a fractionation map was created (width 10 ms, refractory time 30 ms, roving sensitivity 0.1 mv, and threshold of 2). We evaluated the anatomic overlap between PVI lesions and fractionation in regions associated with GP.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Among 52 patients (mean 65 (IQR 46–74) years, 82% male, and 69% paroxysmal AF), sites of fractionation corresponding to GP locations were seen in all cases. PVI ablation incidentally overlapped with fractionation in 50 (96%) patients. On average, 26% of the fractionation corresponding with GP locations were incidentally ablated. The highest proportion of fractionated areas were ablated in the left superior (36%) and right superior (31%) GP regions. More complete incidental ablation of these regions was associated with a greater intraprocedural increase in heart rate (<i>ρ</i> = 0.46, <i>p</i> < 0.001), which was subsequently associated with freedom from AF during 15.9 ± 5.2 months of follow-up.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Patients undergoing AF ablation universally have fractionated electrograms corresponding to anticipated sites of GP. Partial ablation of these regions frequently occurs incidentally during PVI.</p><h3 data-test=\"abstract-sub-heading\">Graphical Abstract</h3>\n","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Incidental ablation of ganglionated plexus during atrial fibrillation ablation\",\"authors\":\"Stephen Keane, Darshak Patel, Brian Otto, Lily Englander, Ramanan Kumareswaran, David Lin, Michael P. Riley, Saman Nazarian, Francis E. Marchlinski, Timothy M. Markman\",\"doi\":\"10.1007/s10840-024-01886-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>Cardioneuroablation targeting the autonomic nerves within ganglionated plexus (GP) has been used to treat atrial fibrillation (AF). Incidental cardioneuroablation may be an important mechanism by which pulmonary vein isolation (PVI) is effective. Automated fractionation mapping software can identify regions of fractionation correlating with GP locations.</p><h3 data-test=\\\"abstract-sub-heading\\\">Objective</h3><p>To examine the overlap between standard PVI ablation lesions and fractionated electrograms suggestive of GP.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>We retrospectively examined AF ablations performed from 2021 to 2023 that included only PVI performed using wide antral circumferential isolation without prospective evaluation of fractionation. Retrospectively, a fractionation map was created (width 10 ms, refractory time 30 ms, roving sensitivity 0.1 mv, and threshold of 2). We evaluated the anatomic overlap between PVI lesions and fractionation in regions associated with GP.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Among 52 patients (mean 65 (IQR 46–74) years, 82% male, and 69% paroxysmal AF), sites of fractionation corresponding to GP locations were seen in all cases. PVI ablation incidentally overlapped with fractionation in 50 (96%) patients. On average, 26% of the fractionation corresponding with GP locations were incidentally ablated. The highest proportion of fractionated areas were ablated in the left superior (36%) and right superior (31%) GP regions. More complete incidental ablation of these regions was associated with a greater intraprocedural increase in heart rate (<i>ρ</i> = 0.46, <i>p</i> < 0.001), which was subsequently associated with freedom from AF during 15.9 ± 5.2 months of follow-up.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusion</h3><p>Patients undergoing AF ablation universally have fractionated electrograms corresponding to anticipated sites of GP. 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Incidental ablation of ganglionated plexus during atrial fibrillation ablation
Background
Cardioneuroablation targeting the autonomic nerves within ganglionated plexus (GP) has been used to treat atrial fibrillation (AF). Incidental cardioneuroablation may be an important mechanism by which pulmonary vein isolation (PVI) is effective. Automated fractionation mapping software can identify regions of fractionation correlating with GP locations.
Objective
To examine the overlap between standard PVI ablation lesions and fractionated electrograms suggestive of GP.
Methods
We retrospectively examined AF ablations performed from 2021 to 2023 that included only PVI performed using wide antral circumferential isolation without prospective evaluation of fractionation. Retrospectively, a fractionation map was created (width 10 ms, refractory time 30 ms, roving sensitivity 0.1 mv, and threshold of 2). We evaluated the anatomic overlap between PVI lesions and fractionation in regions associated with GP.
Results
Among 52 patients (mean 65 (IQR 46–74) years, 82% male, and 69% paroxysmal AF), sites of fractionation corresponding to GP locations were seen in all cases. PVI ablation incidentally overlapped with fractionation in 50 (96%) patients. On average, 26% of the fractionation corresponding with GP locations were incidentally ablated. The highest proportion of fractionated areas were ablated in the left superior (36%) and right superior (31%) GP regions. More complete incidental ablation of these regions was associated with a greater intraprocedural increase in heart rate (ρ = 0.46, p < 0.001), which was subsequently associated with freedom from AF during 15.9 ± 5.2 months of follow-up.
Conclusion
Patients undergoing AF ablation universally have fractionated electrograms corresponding to anticipated sites of GP. Partial ablation of these regions frequently occurs incidentally during PVI.
期刊介绍:
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.