Shun-ichiro Sakamoto, MD, Richard B. Schuessler, PhD, Anson M

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Presentation transcript:

Vagal denervation and reinnervation after ablation of ganglionated plexi Shun-ichiro Sakamoto, MD, Richard B. Schuessler, PhD, Anson M. Lee, MD, Abdulhameed Aziz, MD, Shelly C. Lall, MD, Ralph J. Damiano, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 2, Pages 444-452 (February 2010) DOI: 10.1016/j.jtcvs.2009.04.056 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Surgical ablation sets in each group. LAA, Left atrial appendage; SVC, superior vena cava; RAA, right atrial appendage; IVC, inferior vena cava; GP, ganglionated plexi. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Calculation of change in QRST area for unipolar electrographic analysis. Stim, Stimulation; Pre-Stim, before stimulation. B, Five atrial regions in QRST analysis. RAA, Right atrial appendage; LAA, left atrial appendage; SVC, superior vena cava; SLA, superior left atrium; SRA, superior right atrium; ILA, inferior left atrium; PLA, posterior left atrium; IRA, inferior right atrium; IVC, inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Change in sinus and atrioventricular (AV) intervals in groups 1, 2, and 3. Pre-Ab, Before ablation; Post-Ab, immediately after ablation. Asterisk indicates P < .05 for control versus vagosympathetic trunk stimulation. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Changes in heart rate variability. GP, Ganglionated plexi ablation; PVI, pulmonary vein isolation; BOX, isolation of atria between right and left pulmonary veins; SDNN, SD of normal R-R intervals; rMSSD, root mean square of SD; HF, high-frequency power; LF, low-frequency power. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Upper panel represents atrial activation maps constructed from sinus rhythm without vagal stimulation (A), sinus rhythm with vagal stimulation before ablation (B), and sinus rhythm with vagal stimulation immediately after ablation (C). Lower panel represents sinus activation maps without vagal stimulation (D) and with vagal stimulation (E) at 4 weeks in same animal. Maps represent lateral view in right atrium. Asterisks indicate earliest activation site in right atrium. Atrial activation is shown with color coding in 10-ms increments. Numbers below figure indicate sinus interval times in each activation. RAA, Right atrial appendage; SVC, superior vena cava; RPV, right pulmonary vein; TV, tricuspid valve; IVC, inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Mean QRST area changes at 5 atrial regions before ablation (Pre-Ab), immediately after ablation (Post-Ab), and 4 weeks after ablation. Significantly increased area changes against control values (P < .05) are indicated by shading. stim, Stimulation. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Changes in effective refractory period (ERP) at 5 atrial regions in groups 1, 2, and 3. Pre-Ab, Before ablation; Post-Ab, immediately after ablation; RAA, right atrial appendage; RIA, right inferior atrium; LAA, left atrial appendage; LIA, left inferior atrium; LPA, left posterior atrium. Asterisk indicates P < .05. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 444-452DOI: (10.1016/j.jtcvs.2009.04.056) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions