The role of autonomic denervation during catheter ablation of atrial fibrillation

PURPOSE OF REVIEW: To analyse recent experimental and clinical studies and show that all the pathological events occurring in the myocardium during atrial fibrillation are caused by changes in the autonomic nervous system. The current methods of radiofrequency ablation focus on damaging healthy myocardial tissue involved in the dysregulation caused by autonomic nervous system hyperactivity. Radiofrequency ablation should instead be targeted at compromised nerves and autonomic ganglia (ganglionated plexi). RECENT FINDINGS: Experimental data show that electrical stimulation of the autonomic nervous system may facilitate the induction of atrial fibrillation. The active role of pulmonary veins in atrial fibrillation results from the high density of adrenergic and cholinergic nerves around pulmonary veins. The areas most suitable for autonomic nervous system modification procedures are located in the immediate vicinity of the pulmonary vein-left atrial junction. The first clinical results of radiofrequency ablation of ganglionated plexi resulting in autonomic denervation are encouraging, and show this as a promising approach. There remain many debatable points; the most important of which is the best approach for locating clusters of ganglionated plexi. SUMMARY: Recent experimental and clinical findings have provided new insights into the causes of atrial fibrillation and allowed a re-evaluation of its treatment.