Targets and End Points in Cardiac Autonomic Denervation Procedures

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Targets and End Points in Cardiac Autonomic Denervation Procedures by Esteban W. Rivarola, Denise Hachul, Tan Wu, Cristiano Pisani, Carina Hardy, Fabrizio Raimundi, Sissy Melo, Francisco Darrieux, and Mauricio Scanavacca Circ Arrhythm Electrophysiol Volume 10(2):e004638 February 15, 2017 Copyright © American Heart Association, Inc. All rights reserved.

His bundle electrogram and V6 lead before (A) and after (B) septal ganglionated plexus ablation (patient identification number 8). His bundle electrogram and V6 lead before (A) and after (B) septal ganglionated plexus ablation (patient identification number 8). Significant shortening of R-R (RR) and atrial-His (AH) intervals is observed. Esteban W. Rivarola et al. Circ Arrhythm Electrophysiol. 2017;10:e004638 Copyright © American Heart Association, Inc. All rights reserved.

Electroanatomic maps of the left atrium displaying radiofrequency application sites (anterior and anteroseptal view). Electroanatomic maps of the left atrium displaying radiofrequency application sites (anterior and anteroseptal view). The anterior right ganglionated plexus (GP) and the inferior right GP are targeted, triggering significant Wenckebach cycle length, R-R interval, and atrial-His interval shortening in 64% of the patients. These sites might, therefore, be regarded as critical regions for denervation. Patient identification number (PIN) 9 (upper left), 10 (upper right), 1 (lower left), and 8 (lower right). LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; MA, mitral annulus; RIPV, right inferior pulmonary vein; and RSPV, right superior pulmonary vein. Esteban W. Rivarola et al. Circ Arrhythm Electrophysiol. 2017;10:e004638 Copyright © American Heart Association, Inc. All rights reserved.

Electroanatomic maps of the right atrium displaying radiofrequency applications sites (posterior and posteroseptal view). Electroanatomic maps of the right atrium displaying radiofrequency applications sites (posterior and posteroseptal view). The septal aspect of the superior vena cava junction and the posterior aspect of the interatrial septum, between the posterior wall and the coronary sinus ostium, are critical for vagal denervation in 36% of the studied patients. Patient identification number (PIN) 5 (upper left), 12 (upper right), and 10 (lower right and left). CS indicates coronary sinus ostium; IVC, inferior vena cava; SVC, superior vena cava; and TA, tricuspid annulus. Esteban W. Rivarola et al. Circ Arrhythm Electrophysiol. 2017;10:e004638 Copyright © American Heart Association, Inc. All rights reserved.

Differential effect of certain ganglionated plexus (GP) sites on the sinoatrial and atrioventricular nodes (patient identification number [PIN] 5). Differential effect of certain ganglionated plexus (GP) sites on the sinoatrial and atrioventricular nodes (patient identification number [PIN] 5). A, His bundle electrogram and V6 lead before ablation. B, Ablation of the right atrium (RA) posterior GP results in significant atrial-His (AH) interval shortening (228–102 ms) but no R-R (RR) interval change. R-R shortening (1280–670 ms) is only observed after ablation of the RA superior GP. Esteban W. Rivarola et al. Circ Arrhythm Electrophysiol. 2017;10:e004638 Copyright © American Heart Association, Inc. All rights reserved.