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A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas

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Title: A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas
Authors: Kim, M-Y
Sikkel, MB
Hunter, RJ
Haywood, GA
Tomlinson, DR
Tayebjee, MH
Ali, R
Cantwell, CD
Gonna, H
Sandler, B
Limb, E
Furniss, G
Mrcp, DP
Begg, G
Dhillon, G
Hill, NJ
O'Neill, J
Francis, DP
Lim, PB
Peters, NS
Linton, NWF
Kanagaratnam, P
Item Type: Journal Article
Abstract: INTRODUCTION: The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence AV dissociation. METHODS AND RESULTS: High frequency stimulation was delivered through a Smart-Touch™ catheter in the left atrium of patients undergoing atrial fibrillation (AF) ablation. 3D locations of points tested throughout the entire chamber were recorded on the CARTO™ system. Impact on the AV conduction was categorized as ventricular asystole, bradycardia or no effect. CARTO™ maps were exported, registered and transformed onto a reference left atrial geometry using a custom software, enabling data from multiple patients to be overlaid. In 28 patients, 2108 locations were tested and 283 sites (13%) demonstrated atrioventricular dissociation effects (AVD-GP). There were 10 AVD-GPs (IQR 11.5) per patient. 80% (226) produced asystole and 20% (57) showed bradycardia. The distribution of the two groups were very similar. Highest probability of AVD-GPs (>20%) were identified in: infero-septal portion (41%) and right inferior pulmonary vein base (30%) of the posterior wall, right superior pulmonary vein antrum (31%). CONCLUSION: It is feasible to map the entire left atrium for AVD-GPs prior to AF ablation. Aggregated data from multiple patients, producing a distribution probability atlas of AVD-GPs, identified three regions with a higher likelihood for finding AVD-GPs and these matched the histological descriptions. This approach could be used to better characterise the autonomic network. This article is protected by copyright. All rights reserved.
Issue Date: 1-Dec-2018
Date of Acceptance: 31-Aug-2018
URI: http://hdl.handle.net/10044/1/62349
DOI: https://dx.doi.org/10.1111/jce.13723
ISSN: 1045-3873
Publisher: Wiley
Start Page: 1624
End Page: 1634
Journal / Book Title: Journal of Cardiovascular Electrophysiology
Volume: 29
Issue: 12
Copyright Statement: © 2018 John Wiley & Sons Ltd. This is the pre-peer reviewed version of the following article: Kim, M. , Sikkel, M. B., Hunter, R. J., Haywood, G. A., Tomlinson, D. R., Tayebjee, M. H., Ali, R. , Cantwell, C. D., Gonna, H. , Sandler, B. , Limb, E. , Furniss, G. , MRCP, D. P., Begg, G. , Dhillon, G. , Hill, N. J., O’Neill, J. , Francis, D. P., Lim, P. B., Peters, N. S., Linton, N. W. and Kanagaratnam, P. (2018), A Novel Approach to Mapping the Atrial Ganglionated Plexus Network by Generating a Distribution Probability Atlas. Journal of Cardiovascular Electrophysiology. Accepted Author Manuscript., which has been published in final form at https://dx.doi.org/10.1111/jce.13723
Sponsor/Funder: Imperial College Trust
Funder's Grant Number: na
Keywords: atrial fibrillation
autonomic nervous system
ganglionated plexus
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: United States
Online Publication Date: 2018-08-31
Appears in Collections:Faculty of Engineering
Bioengineering
National Heart and Lung Institute
Aeronautics
Faculty of Medicine



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