title: Ganglionated plexi ablation directed by high-frequency stimulation and complex fractionated atrial electrograms for paroxysmal atrial fibrillation.
abstract: BACKGROUND
  The effectiveness of ganglionated plexi (GP) ablation in patients with atrial fibrillation (AF) is ambiguous. Some researchers had already suggested that additional identification of complex fractionated atrial electrograms (CFAE) around the areas with a positive reaction to high-frequency stimulation (HFS) might improve the accuracy of GP's boundaries location, then enhancing the success rate of ablation. The purpose of this study was to assess the safety and efficacy of GP ablation directed by HFS and CFAE in patients with paroxysmal AF (PAF).
  
  
  RESULTS
  Sixty-two patients with PAF (age 57±8 years) underwent GP ablation. Ablation targets were the sites where vagal reflexes were evoked by HFS and additional extended ablation CFAE area around the areas where vagal reflexes were evoked. At 12 months, 71% of patients were free of symptomatic AF. At 3 months after ablation the root mean square successive differences and HF were significantly lower in patients without AF recurrence (P < 0.0001 and P = 0.004). The LF/HF ratio was significantly higher in patients without AF recurrence (P = 0.02).
  
  
  CONCLUSIONS
  Enhanced GP ablation directed by HFS and CFAE can be safely performed and enables maintenance of sinus rhythm in the majority of patients with PAF for a 12-month period. Denervation of the intrinsic cardiac autonomic nervous system may be the preferable target of catheter ablation of AF.
authors.affiliation: Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia. E.Pokushalov@gmail.com
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.forename: Sergey
authors.initials: S
authors.lastname: Artyomenko
authors.forename: Natalya
authors.initials: N
authors.lastname: Shirokova
authors.forename: Alex
authors.initials: A
authors.lastname: Turov
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
authors.forename: Demosthenes G
authors.initials: DG
authors.lastname: Katritsis
authors.forename: Sunny S
authors.initials: SS
authors.lastname: Po
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D005726:Ganglia, Parasympathetic / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome