title: Features of intrinsic ganglionated plexi in both atria after extensive pulmonary isolation and their clinical significance after catheter ablation in patients with atrial fibrillation.
abstract: BACKGROUND
  The features of intrinsic ganglionated plexi (GP) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF).
  
  
  OBJECTIVE
  The purpose of this study was to assess the features of GP response after extensive PVI and to evaluate the relationship between GP responses and subsequent AF episodes.
  
  
  METHODS
  The study population consisted of 216 consecutive AF patients (104 persistent AF) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI.
  
  
  RESULTS
  GP responses were determined in 186 of 216 patients (85.6%). In the left atrium, GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%) and around the left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area: inside the CS in 64 of 216 patients (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (hazard ratio 4.04, confidence interval 1.48-11.0) in patients with paroxysmal, but not persistent, AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% vs 8% in those without a GP response (P = .002).
  
  
  CONCLUSIONS
  The presence of GP responses after extensive PVI was significantly associated with increased AF recurrence after ablation in patients with paroxysmal AF.
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan. Electronic address: drk21cent@gmail.com.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kurotobi
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kino
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Kazato
authors.initials: K
authors.lastname: Ito
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tonomura
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yano
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Tanaka
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuchida
authors.affiliation: Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukumoto
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005725:Ganglia, Autonomic / Q000503:physiopathology / Q000601:surgery*; D006325:Heart Atria / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
keywords: Atrial fibrillation; Autonomic nervous system; Catheter ablation; Pulmonary vein