title: Identification of left atrial ganglionated plexi by dense epicardial mapping as ablation targets for the treatment of concomitant atrial fibrillation.
abstract: BACKGROUND
  Autonomic ganglionated plexi (GPs) play a significant role in the initiation and maintenance of atrial fibrillation (AF). GPs are key targets for a maze procedure. The purpose of this study was to identify the location of the left atrial GPs based on dense epicardial mapping during a maze procedure in patients with concomitant AF.
  
  
  METHODS
  Sixteen patients (age, 68 ± 10 years; 11 males, 69%) with heart failure and concomitant AF (duration 55 ± 86 months) underwent intraoperative epicardial electrophysiological mapping and a GP ablation using the maze procedure at our institution. Twenty-four-site, high-frequency stimulation (1,000/min; output, 18 V; pulse width, 0.75 ms) was performed by placing tweezers directly onto the potential GP sites on the left atrial epicardium.
  
  
  RESULTS
  Active GPs were found in 13 (81%) of the 16 patients, and 12 (92%) of 13 patients had active GPs between the right pulmonary veins (PVs) and the interatrial groove. For those patients with active locations, a 7-day event-loop recording demonstrated that 12 (92%) of 13 patients were maintained in sinus rhythm 3 months after the operation.
  
  
  CONCLUSIONS
  Dense epicardial mapping in the potential GP areas identified active GP locations in a high percentage of patients. GPs between the PVs and interatrial groove have a high potential as ablation targets for treatment of concomitant AF.
authors.affiliation: Department of Cardiovascular Medicine.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kondo
authors.forename: Marehiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Michiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishimura
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Kajiyama
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashiguchi
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kanaeda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakano
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Hiranuma
authors.forename: Toru
authors.initials: T
authors.lastname: Ishizaka
authors.forename: Goro
authors.initials: G
authors.lastname: Matsumiya
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005725:Ganglia, Autonomic / Q000601:surgery*; D006325:Heart Atria / Q000601:surgery; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
keywords: atrial fibrillation; autonomic nervous system; ganglionated plexi; maze procedure