Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Tolga Aksu; Jamario R Skeete; Henry H Huang

doi:10.15420/aer.2022.37

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Arrhythm Electrophysiol Rev. 2023 Jan:12:e02. doi: 10.15420/aer.2022.37.

Authors

Tolga Aksu¹, Jamario R Skeete², Henry H Huang²

Affiliations

¹ Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey.
² Department of Cardiology, Rush Medical College, Chicago, IL, US.

Abstract

As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.

Keywords: Cardioneuroablation; atrial fibrillation; autonomic nervous system; ganglionated plexus.

Publication types

Review