Anatomic guided ablation of the atrial right ganglionated plexi is
enough for cardiac autonomic modulation in patients with significant
bradyarrhythmias
Abstract
Introduction: Cardiac autonomic system modulation by endocardial
ablation targeting atrial ganglionated plexi (GP) is an alternative
strategy in selected patients with severe functional bradyarrhythmias,
although no consensus exists on the best ablation strategy. The aim of
this study was to evaluate if a simplified approach by a purely
anatomical guided ablation of just the atrial right GP is enough for the
treatment of these patients. Methods: We prospectively enrolled patients
with significant functional bradyarrhythmias and performed endocardial
ablation purely guided by 3D electroanatomic mapping directed at the
atrial right GP and accessed parameters of parasympathetic modulation
and recurrence of bradyarrhythmias. Results: Thirteen patients enrolled
(76.9% male, median age 51, 42-63 years). After ablation, a median RR
interval shortening of 28.3 (25.6–40.3)% occurred (111, 937.5-1395.4ms
to 722.9, 652.2-882.4ms, p=0.0015). The AH interval also shortened (19,
10.5–35.7%) significantly after the procedure (115, 105-122ms to 85,
71-105ms, p=0.002) as well as Wenckebach cycle length (11.1, 5.9–17.8%
shortening) from 450, 440-510ms to 430, 400-460ms, p=0.0014. On 24-hour
Holter monitoring there was significant increase in heart rates (HR) of
patients after ablation (minimal HR increased from 34 (26-43)bpm to 49
(43–56)bpm, p=0,0063 and mean HR from 65 (47-72)bpm to 78 (67-87)bpm,
p=0.0015). No patients had recurrence of symptoms or significant
bradyarrhythmias during a median follow-up of 8.4 months. Conclusions: A
purely anatomic guided procedure directed only at the atrial right
ganglionated plexi seems to be enough as a therapeutic approach for
cardiac parasympathetic modulation in selected patients with significant
functional bradyarrhythmias.