title: Anatomical proximity between ganglionated plexi and epicardial adipose tissue in the left atrium: implication for 3D reconstructed epicardial adipose tissue-based ablation.
abstract: OBJECTIVE
  We sought to better understand the association between and clinical implications of ganglionated plexi (GPs), epicardial adipose tissue (EAT) in the left atrium (LA), and the initiation and maintenance of atrial fibrillation (AF).
  
  
  METHODS
  Three-dimensional (3D) computed tomography (CT) reconstruction images of the LA, PVs, and LA-EAT were merged with the LA geometry for 25 with paroxysmal AF (PAF) and 15 with persistent AF (PerAF) scheduled for ablation. High-frequency stimulation (20 Hz, 25 mA, 10 ms) was performed at three sites within each of the five major anatomical LA GPs (superior left, inferior left, anterior right, inferior right, and Marshall tract GPs) to elicit vagal responses. Correspondence between the five GP areas and vagal response sites, LA-EAT, and complex fractionated atrial electrograms (CFAEs) was examined. The long-term outcomes of adjuvant LA-EAT-based ablation were assessed in 31 patients with PAF and 102 with PerAF.
  
  
  RESULTS
  LA-EAT overlapped 93 ± 14 % of five major anatomical GP areas, and the vagal response sites and CFAE sites corresponded to 77 ± 23 and 76 ± 25 %, respectively (p < 0.05 for both vs. LA-EAT locations). The EAT-based ablation eliminated 97.6 % of the vagal response sites and lengthened the AF cycle from 160 ± 26 to 193 ± 27 ms (p < 0.001). The 2-year arrhythmia-free rate after EAT-based ablation was 72 % in the PAF group and 73 % in the PerAF group (p = 0.614).
  
  
  CONCLUSIONS
  LA-EAT tends to overlie the major anatomical GP areas including most of the active GP response sites and CFAEs associated with AF. Ablation of GPs and CFAEs may explain the long-term efficacy of EAT-based ablation following extensive encircling pulmonary vein isolation (EEPVI) for AF.
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan. yasuwo128@yahoo.co.jp.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Sonoda
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Sasaki
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Rikitake
authors.initials: R
authors.lastname: Kogawa
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Iso
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Kurokawa
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Kimie
authors.initials: K
authors.lastname: Ohkubo
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Nihon Kohden Corporation, Tokyo, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Nikaido
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation; D056149:Epicardial Mapping / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
keywords: Atrial fibrillation; Epicardial adipose tissue; Ganglionated plexi