title: Catheter ablation of right atrial ganglionated plexi in patients with vagal paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Catheter ablation of ganglionated plexi (GP) in the left atrium has been proposed in different subgroup of patients with atrial fibrillation (AF). Anatomic studies found a high prevalence of GP in the posterior surface of the right atrium (RA). Experimental data suggested the potential role of right atrial GP in the AF initiation and maintenance. The aim of our study was to assess the efficacy of GP ablation in RA in patients with vagal AF.
  
  
  RESULTS
  Thirty-four patients without structural heart diseases were randomly assigned for a selective ablation procedure targeted on the elimination of vagal reflex evoked by high frequency stimulation or an extensive approach at anatomic sites of GP. All patients underwent Holter ECG and heart rate variability evaluation at baseline and at 3, 6, 12, and 18 months of follow-up. At a mean follow-up of 19.7±5.2 months, AF recurred in 5 of 17 patients with anatomic ablation and in 13 of 17 patients with a selective approach (P=0.01). No patient had major complications. After ablation, heart rate variability parameters showed a significant parasympathetic (and sympathetic) denervation in the first 6 months, which was more prominent in patients with anatomic GP ablation and in those without AF recurrence.
  
  
  CONCLUSIONS
  This study demonstrates that in a selected population of vagal paroxysmal AF, the anatomic ablation of GPs in the RA is effective in about 70% of patients. These results confirm that atrial vagal denervation can abolish AF, as suggested by experimental and clinical data.
authors.affiliation: Division of Cardiology, Policlinico Casilino, ASL Roma B, Rome, Italy. leonardo.calo@tin.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
authors.forename: Marco
authors.initials: M
authors.lastname: Rebecchi
authors.forename: Luigi
authors.initials: L
authors.lastname: Sciarra
authors.forename: Lucia
authors.initials: L
authors.lastname: De Luca
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fagagnini
authors.forename: Lorenzo Maria
authors.initials: LM
authors.lastname: Zuccaro
authors.forename: Pietro
authors.initials: P
authors.lastname: Pitrone
authors.forename: Serena
authors.initials: S
authors.lastname: Dottori
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porfirio
authors.forename: Ermenegildo
authors.initials: E
authors.lastname: de Ruvo
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lioy
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003714:Denervation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000294:innervation* / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*