What question did this study set out to answer?

To determine whether electrical activation of the intrinsic cardiac autonomic nervous system via stimulation of atrial ganglionated plexi directly initiates pulmonary vein ectopy and atrial fibrillation in humans.

January 15, 2011Journal of Cardiovascular Electrophysiology

Intrinsic Cardiac Autonomic Stimulation Induces Pulmonary Vein Ectopy and Triggers Atrial Fibrillation in Humans

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Why the study?

Does high frequency stimulation of atrial ganglionated plexi induce pulmonary vein ectopy and atrial fibrillation in patients with paroxysmal AF?

Population

12 patients undergoing ablation for paroxysmal atrial fibrillation

Comparison

Short bursts of high frequency stimulation… vs Baseline state without high frequency stimulation

Design

Case_series

Authors

PLPhang Boon LimImperial College Healthcare NHS Trust LMLouisa Malcolme‐LawesImperial College Healthcare NHS Trust TSThomas StüberKlinikum Itzehoe

Discussion

Member takes

Implication

High-frequency stimulation of ganglionated plexi may trigger ectopy and AF; leaves open whether targeted ablation improves outcomes.

Key Points

To determine whether electrical activation of the intrinsic cardiac autonomic nervous system via stimulation of atrial ganglionated plexi directly initiates pulmonary vein ectopy and atrial fibrillation in humans.
Studied 12 patients with paroxysmal atrial fibrillation undergoing ablation during sinus rhythm.
Delivered short bursts of high-frequency stimulation (HFS) synchronized to local atrial refractory periods at presumed ganglionated plexi sites.
Recorded intracardiac electrograms across 112 HFS episodes using catheters in the pulmonary veins, coronary sinus, and high right atrium.
HFS induced ectopic activity in 91 of 112 (81%) episodes, resulting in 46 single ectopic beats, 5 double responses, 24 runs of ectopy/tachycardia lasting <30 seconds, and 16 episodes of atrial fibrillation lasting >30 seconds.
When the catheter was adjacent to the stimulated ganglionated plexi (63 of 91 episodes), ectopy was recorded earliest in the pulmonary vein in 48 of 63 (76%) episodes.
In one patient, reproducible ectopy occurred exclusively following HFS-induced atrioventricular nodal conduction delay, with neither phenomenon occurring in the absence of stimulation.

Structured PICO

Does high frequency stimulation of atrial ganglionated plexi induce pulmonary vein ectopy and atrial fibrillation in patients with paroxysmal AF?

Population

12 patients undergoing ablation for paroxysmal atrial fibrillation

Intervention

Short bursts of high frequency stimulation (HFS), synchronized to the local atrial refractory period, delivered at presumed ganglionated plexi (GP) sites

Comparator

Baseline state without high frequency stimulation

Outcome

Induction of ectopic activity (pulmonary vein ectopy or atrial fibrillation)surrogate

Activation of the intrinsic cardiac autonomic nervous system via high-frequency stimulation directly induces pulmonary vein ectopy and atrial fibrillation in humans.

Cite This Study

Lim et al. (2011) studied this question.

synapsesocial.com/papers/6a7f2e7eeadf0d493516c296 https://doi.org/10.1111/j.1540-8167.2010.01992.x

Topics

Atrial fibrillation Persistent AF management

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Intrinsic Cardiac Autonomic Stimulation Induces Pulmonary Vein Ectopy and Triggers Atrial Fibrillation in Humans

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Intrinsic Cardiac Autonomic Stimulation Induces Pulmonary Vein Ectopy and Triggers Atrial Fibrillation in Humans

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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