Anatomical and electrophysiological localization of ganglionated plexi using high-density 3D CARTO mapping system

The autonomic nervous system can be visualized with a 3D map created in the CARTO® 3 system. This advanced imaging technology utilizes electromagnetic technology to create real-time three-dimensional (3D) maps of a patient's cardiac structures. Unique electrocardiograms with established length and fractionations reflect the position of neuronal ganglionated plexi. Radiofrequency ablation of such ganglionated plexi modifies chronotropic and dromotropic effects, potentially reducing recurrences of atrial fibrillation. The present study provides quantitative and qualitative information about the presence of ganglionated plexi in specific heart regions among patients with paroxysmal atrial fibrillation. Thirty-five patients referred for primary atrial fibrillation ablation were retrospectively inspected for ganglionated plexi presence in high-density mapping. Right anterior and left superior ganglionated plexus were consistently observed in all hearts. Other ganglionated plexi were tracked from 85.7 – to 42.8%. Less often, fragmented potentials were observed in the coronary sinus. The highest amount of low amplitude potentials was recorded in the left inferior ganglionated plexus. Using a high-density mapping, ganglionated plexi identification is quick and feasible in reconsidering ablation strategy for selected patients who develop atrial fibrillation.