Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

Figures

• 

  Figure 1. Location of key atrial ganglionated plexi (GP). Oblique sinus (OS), right superior (RS), transverse sinus (TS), left superior (LS) and ligament of Marshall (LM).

• 

  Figure 2. Tyrosine kinase staining of an unablated GP (left) and a pulsed field ablated GP (right). The unablated control shows uptake of the stain, confirming neuron functionality, while the ablated sample shows no uptake, indicating cell death.

• 

  Figure 3. Temporal dynamics of cell death in neurons and cardiomyocytes. The permeability of cells to PI was measured at 1000 V/cm 30 pulses, 1000 V/cm 60 pulses, 1250 V/cm 30 pulses, and 1250 V/cm 60 pulses in neurons (A) and cardiomyocytes (C). The evolution of PI permeable cells was detected at 0.5 (in red), 3 (in blue) and 24 (in green) hours for neurons (B) and cardiomyocytes (D). All data shown as mean ± SEM. Statistical significance was performed using two-way ANOVA (* p < 0.05, ** p < 0.005, *** p < 0.001, **** p < 0.0001). Reprinted with permission from [60] through the Creative Commons attribution license.

• 

  Figure 4. Electric field distribution around the target epicardial site, without (A) and with (B) a saline layer. The electrode is embedded 0.25 mm in the fat layer. The white contour corresponds to the 1000 V/cm electric field isoline. Reprinted with permission from [66] through the Creative Commons Attribution License.

• 

  Figure 5. Paired baseline and post-ablation AERP values for patients in safety and feasibility study.

• 

  Figure 6. Schematic of endocardial PVI lesions (blue) and epicardial GP locations (yellow).

• 

  Figure 7. Patient heart rates collected at baseline, day 1 postablation, and 3 months postablation. The asterisk (*) indicates statistical significance (p ≤ 0.05, paired t-test) compared to baseline heart rates. Total of 40 patients in each group. Bars indicate median heart rate. BPM = beats/min; Cryo = cryoballoon ablation; PFA = pulsed field ablation; RFA = radiofrequency ablation. Reprinted with permission from [78]; Copyright © 2022 Elsevier.