Epicardial ablation of right pulmonary artery ganglionated plexi for the prevention of atrial fibrillation originating in the pulmonary veins

Abstract

PROBLEM PRESENTED: A novel study of catheter ablation of the right pulmonary artery ganglionated plexi (RPA GP) to reduce atrial fibrillation (AF) originating in the pulmonary veins (PVs) is presented.

Studies undertaken: In 20 dogs, atrial effective refractory periods (AERPs), PVERP, and the dispersion of AERP (dAERP) were measured at baseline during RPA GP stimulation and after ablation. Programmed stimulation and burst stimulation protocols were performed at 4 distal PVs to measure the percentage of AF induced before and after ablation.

Results: Stimulation of the RPA GP shortened AERP (116 +/- 16 vs 130 +/- 10 milliseconds, P < .01) and PVERP (122 +/- 14 vs 136 +/- 12 milliseconds, P < .01), and increased dAERP (31 +/- 6 vs 23 +/- 6 milliseconds, P < .01). However, the above indices revealed an adverse change after excision (AERP, 138 +/- 7 vs 130 +/- 10 milliseconds; PVERP, 146 +/- 18 vs 136 +/- 12 milliseconds; and dAERP, 19 +/- 5 vs 23 +/- 6 milliseconds; P < .05). Furthermore, the percentage of AF induced from PVs was significantly reduced with vagosympathetic stimulation (40% vs 90%, P < .01).

Conclusions: Ablation of the RPA GP changes the electrophysiologic properties of both the atria and the PVs and decreases AF inducibility arising from the PVs.