title: Exploration of theoretical ganglionated plexi ablation technique in atrial fibrillation surgery.
abstract: BACKGROUND
  Ganglionated plexi ablation during atrial fibrillation surgery is not technically standardized for precise ganglionated plexi locations or ablation sequence. We aimed to identify precise active ganglionated plexi locations in patients with structural heart disease and explore the feasibility of anatomic ganglionated plexi ablation without prior mapping in patients with atrial fibrillation.
  
  
  METHODS
  Thirty patients with valvular disease-associated atrial fibrillation underwent ganglionated plexi ablation and a modified maze procedure. In 20 patients, ganglionated plexi mapping was performed to identify active plexi. According to mapping results, anatomically determined plexi were ablated without mapping in the final 10 patients. Ganglionated plexi ablation outcomes with and without prior mapping were compared between perioperative and early postoperative periods.
  
  
  RESULTS
  Active ganglionated plexi common to more than 20% of patients were identified in the superior and inferior right pulmonary veins, superior left pulmonary vein, interatrial groove, and inferior left atrium. Inferior left atrial plexi ablation resulted in maximum vagal modulation. Compared with ablation using mapping, anatomic ablation yielded more vagal modulation in heart rate variability and decreased the requisite cardiopulmonary bypass time.
  
  
  CONCLUSIONS
  The sequential pacing and ablation technique identified an optimal ablation sequence that best ensured vagal reflex elimination from all ganglionated plexi. Anatomic ablation using a predetermined ganglionated plexi map may be a viable alternative to individual plexus mapping before ablation.
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan. Electronic address: saka-165@nms.ac.jp.
authors.forename: Shun-ichiro
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fujii
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiromoto
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ishii
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Morota
authors.affiliation: Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nitta
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D005725:Ganglia, Autonomic / Q000503:physiopathology / Q000601:surgery*; D015171:Ganglionectomy / Q000379:methods*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult