Key result
Dense epicardial mapping identified active ganglionated plexi in 81% of patients, and 92% of those with active locations maintained sinus rhythm at 3 months post-ablation.
Why the study?
Does dense epicardial mapping and GP ablation during a maze procedure identify active GP locations and maintain sinus rhythm in patients with heart failure and concomitant AF?
Observational (n=16)
No
Does dense epicardial mapping and GP ablation during a maze procedure identify active GP locations and maintain sinus rhythm in patients with heart failure and concomitant AF?
Dense epicardial mapping during a maze procedure successfully identifies active ganglionated plexi, which serve as effective ablation targets for maintaining sinus rhythm in patients with concomitant AF.
May support GP ablation during maze for AF; hypothesis-generating from Level 5 data and requires randomized confirmation before practice change.
BACKGROUND: Autonomic ganglionated plexi (GPs) play a significant role in the initiation and maintenance of atrial fibrillation (AF). GPs are key targets for a maze procedure. The purpose of this study was to identify the location of the left atrial GPs based on dense epicardial mapping during a maze procedure in patients with concomitant AF. METHODS: Sixteen patients (age, 68 ± 10 years; 11 males, 69%) with heart failure and concomitant AF (duration 55 ± 86 months) underwent intraoperative epicardial electrophysiological mapping and a GP ablation using the maze procedure at our institution. Twenty-four-site, high-frequency stimulation (1,000/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. RESULTS: Active GPs were found in 13 (81%) of the 16 patients, and 12 (92%) of 13 patients had active GPs between the right pulmonary veins (PVs) and the interatrial groove. For those patients with active locations, a 7-day event-loop recording demonstrated that 12 (92%) of 13 patients were maintained in sinus rhythm 3 months after the operation. CONCLUSION: Dense epicardial mapping in the potential GP areas identified active GP locations in a high percentage of patients. GPs between the PVs and interatrial groove have a high potential as ablation targets for treatment of concomitant AF.
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Kondo et al. (2013) conducted an observational in Heart failure and concomitant atrial fibrillation (n=16). Intraoperative epicardial electrophysiological mapping and ganglionated plexi ablation was evaluated on Maintenance of sinus rhythm at 3 months. Dense epicardial mapping identified active ganglionated plexi in 81% of patients, and 92% of those with active locations maintained sinus rhythm at 3 months post-ablation.
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