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January 14, 2008Circulation214 citations

Pulmonary Vein Autonomic Ganglia Ablation in Experimental Vagal Atrial Fibrillation

Pulmonary Vein Region Ablation in Experimental Vagal Atrial Fibrillation

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Why the study?

Does ablation of pulmonary veins versus peri-PV autonomic ganglia suppress experimental vagal atrial fibrillation in a canine model?

Population

Canine left atrial pulmonary vein preparations in vitro and dogs in vivo

Comparison

Excision of all PVs, isolation of all PVs with… vs Baseline and partial ablation

Design

Preclinical

Authors

KLKristina LemolaDCDenis ChartierYYYung‐Hsin Yeh

Discussion

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Overview

Peri-PV ganglia ablation may explain PV isolation benefits in experimental vagal AF; leaves open translation to patients.

Key Points

  • To determine whether pulmonary veins or adjacent autonomic ganglia play the primary role in maintaining experimental vagal atrial fibrillation.
  • Evaluated cholinergic atrial fibrillation in vitro using coronary-perfused canine left atrial pulmonary vein preparations during carbachol infusion before and after vein excision.
  • Tested sustained atrial fibrillation in vivo in dogs via cervical vagal stimulation before and after pulmonary vein isolation with a bipolar radiofrequency ablation clamp.
  • Identified autonomic ganglia by high-frequency subthreshold stimulation responses and performed targeted radiofrequency ablation of ganglia overlying pulmonary vein ostia.
  • Carbachol promoted atrial fibrillation dose-dependently in vitro, and sustained atrial fibrillation remained readily inducible in vivo following complete pulmonary vein isolation or excision.
  • Ablation of autonomic ganglia overlying all pulmonary vein ostia abolished vagal-induced refractory period shortening and suppressed atrial fibrillation, whereas unilateral ostial ganglion ablation failed.
  • Dominant-frequency analysis showed that suppression of vagal atrial fibrillation corresponded to the elimination of high-frequency driver regions around the autonomic ganglia.

Structured PICO

Does ablation of pulmonary veins versus peri-PV autonomic ganglia suppress experimental vagal atrial fibrillation in a canine model?

P
Population
Canine left atrial pulmonary vein preparations in vitro and dogs in vivo
I
Intervention
Excision of all PVs (in vitro), isolation of all PVs with encircling lesions (in vivo), and ablation of autonomic ganglia overlying PV ostia
C
Comparator
Baseline (before isolation) and partial ablation (only left- or right-sided PV ostial ganglia)
O
Outcome
Atrial fibrillation promotion/maintenance and effective refractory period responses to cholinergic stimulationsurrogate

Intact pulmonary veins are not required for maintaining experimental cholinergic AF, and the effectiveness of PV-directed ablation in vagal AF may be driven by the elimination of autonomic ganglia at the PV base.

Cite This Study

Lemola et al. (2008) studied this question.

synapsesocial.com/papers/6a1e801a09554abc3868e3f8https://doi.org/10.1161/circulationaha.107.737023
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The role of pulmonary veins vs. autonomic ganglia in different experimental substrates of canine atrial fibrillation2010 · 70 citations
  2. 2Effects of Pulmonary Vein Ablation on Regional Atrial Vagal Innervation and Vulnerability to Atrial Fibrillation in Dogs2005 · 154 citations
  3. 3An Experimental Study on the Site Dependency and Mechanism of Vagal Denervation Following Radiofrequency Catheter Ablation for Supraventricular Arrhythmias Including Atrial Fibrillation2008 · 6 citations
  4. 4Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation2008 · 13 citations
  5. 5The Autonomic Nervous System and Atrial Fibrillation:The Roles of Pulmonary Vein Isolation and Ganglionated Plexi Ablation.2009 · 13 citations