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(Circulation. 2008;117:470-477.)
© 2008 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Pulmonary Vein Region Ablation in Experimental Vagal Atrial Fibrillation

Role of Pulmonary Veins Versus Autonomic Ganglia

Kristina Lemola, MD; Denis Chartier, BSc; Yung-Hsin Yeh, MD; Marc Dubuc, MD; Raymond Cartier, MD; Andrew Armour, PhD; Michael Ting, PhD; Masao Sakabe, MD, PhD; Akiko Shiroshita-Takeshita, MD, PhD; Philippe Comtois, PhD; Stanley Nattel, MD

From the Departments of Medicine (K.L., D.C., Y.-H.Y., M.D., M.S., A.S.-T., P.C., S.N.) and Surgery (R.C.) and Research Center, Montreal Heart Institute, and Research Center, Sacre-Coeur Hospital (A.A.), Montreal, Quebec, Canada; Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan (Y.-H.Y.); Department of Medicine, University Hospital Zurich, Zurich, Switzerland (K.L.); and Université de Montréal, Montreal, Quebec, Canada, and Seagate Technology, Pittsburgh, Pa (M.T.).

Correspondence to Stanley Nattel, 5000 Belanger St E, Montreal, Quebec, H1T 1C8, Canada. E-mail stanley.nattel{at}icm-mhi.org

Received August 27, 2007; accepted November 20, 2007.

Background— Pulmonary vein (PV) –encircling radiofrequency ablation frequently is effective in vagal atrial fibrillation (AF), and there is evidence that PVs may be particularly prone to cholinergically induced arrhythmia mechanisms. However, PV ablation procedures also can affect intracardiac autonomic ganglia. The present study examined the relative role of PVs versus peri-PV autonomic ganglia in an experimental vagal AF model.

Methods and Results— Cholinergic AF was studied under carbachol infusion in coronary perfused canine left atrial PV preparations in vitro and with cervical vagal stimulation in vivo. Carbachol caused dose-dependent AF promotion in vitro, which was not affected by excision of all PVs. Sustained AF could be induced easily in all dogs during vagal nerve stimulation in vivo both before and after isolation of all PVs with encircling lesions created by a bipolar radiofrequency ablation clamp device. PV elimination had no effect on atrial effective refractory period or its responses to cholinergic stimulation. Autonomic ganglia were identified by bradycardic and/or tachycardic responses to high-frequency subthreshold local stimulation. Ablation of the autonomic ganglia overlying all PV ostia suppressed the effective refractory period–abbreviating and AF-promoting effects of cervical vagal stimulation, whereas ablation of only left- or right-sided PV ostial ganglia failed to suppress AF. Dominant-frequency analysis suggested that the success of ablation in suppressing vagal AF depended on the elimination of high-frequency driver regions.

Conclusions— Intact PVs are not needed for maintenance of experimental cholinergic AF. Ablation of the autonomic ganglia at the base of the PVs suppresses vagal responses and may contribute to the effectiveness of PV-directed ablation procedures in vagal AF.

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CLINICAL PERSPECTIVE

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