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A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas
Author(s) -
Kim MinYoung,
Sikkel Markus B.,
Hunter Ross J.,
Haywood Guy A.,
Tomlinson David R.,
Tayebjee Muzahir H.,
Ali Rheeda L.,
Cantwell Chris D.,
Gonna Hanney,
Sandler Belinda C.,
Lim Elaine,
Furniss Guy,
Panagopoulos Dimitrios,
Begg Gordon,
Dhillon Gurpreet,
Hill Nicola J.,
O’Neill James,
Francis Darrel P.,
Lim Phang Boon,
Peters Nicholas S.,
Linton Nick W. F.,
Kanagaratnam Prapa
Publication year - 2018
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13723
Subject(s) - medicine , atrial fibrillation , pulmonary vein , ablation , catheter ablation , orthodromic , cardiology , atrium (architecture) , stimulation
The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence atrioventricular (AV) dissociation. Methods and Results High frequency stimulation was delivered through a Smart‐Touch catheter in the left atrium of patients undergoing atrial fibrillation (AF) ablation. Three dimensional locations of points tested throughout the entire chamber were recorded on the CARTO™ system. Impact on the AV conduction was categorized as ventricular asystole, bradycardia, or no effect. CARTO maps were exported, registered, and transformed onto a reference left atrial geometry using a custom software, enabling data from multiple patients to be overlaid. In 28 patients, 2108 locations were tested and 283 sites (13%) demonstrated (AVD‐GP) effects. There were 10 AVD‐GPs (interquartile range, 11.5) per patient. Eighty percent (226) produced asystole and 20% (57) showed bradycardia. The distribution of the two groups was very similar. Highest probability of AVD‐GPs (>20%) was identified in: inferoseptal portion (41%) and right inferior pulmonary vein base (30%) of the posterior wall, right superior pulmonary vein antrum (31%). Conclusion It is feasible to map the entire left atrium for AVD‐GPs before AF ablation. Aggregated data from multiple patients, producing a distribution probability atlas of AVD‐GPs, identified three regions with a higher likelihood for finding AVD‐GPs and these matched the histological descriptions. This approach could be used to better characterize the autonomic network.