Electrical stimulation to identify neural elements on the heart : Their role in atrial fibrillation

摘要: Experimental Studies: Anesthetized dogs were subjected to a right then left thoracotomy. Two modes of electrical stimulation used activate ganglionated plexi (GP) on the epicardium atria: (1) Near base each pulmonary vein (PV), trains high frequency stimuli (HFS) coupled atrial paced beat so as fall within refractory period achieve nerve without excitation; and (2) Continuous HFS was applied via plaque electrodes sutured epicardial fat pads (containing GP) near superior (RS) (LS) PVs. The chest closed. An ablation catheter, inserted percutaneously, positioned fluoroscopically in atrium across from electrode RSPV. Transeptal puncture place an catheter at LSPV-left junction. induced fibrillation (AF) also caused grade AV block due strong parasympathetic effect node. Radiofrequency endocardium abolished vagal response delivered close RSPV LSPV, respectively. Clinical Sixty (60) patients with paroxysmal or persistent AF underwent PV antrum isolation (27 patients) plus GP (33 patients). Endocardial border antra 4 GPs produced (vagal response) during AF. RFA these sites response. Testing small number very short follow-up suggests that adding may increase success (absence recurrence) 70% 91%. Conclusions: These basic clinical studies suggest localized cardiac autonomic ganglia (GPs) play critical role initiation maintenance