Mapping and Ablation of the Cardiac Autonomic Nervous System to Treat Atrial Fibrillation

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Hyperactivity of the cardiac autonomic nervous system provides the triggers for rapid pulmonary vein or atrial firing as well as the substrate (e.g., dispersion and shortening of refractoriness) for perpetuation of atrial fibrillation (AF). The current therapy to maintain sinus rhythm in patients with drug-refractory AF is surgical or catheter ablation. A more accurate and specific means of identifying and ablating the arrhythmogenic autonomic substrates, particularly ganglionated plexi (GP), can potentially improve the success of AF ablation and minimize introducing arrhythmogenic substrates. This chapter discusses various clinical assessments that help in identifying the arrhythomogenic autonomic substrates. Each GP contains both parasympathetic and sympathetic neural elements; stimulation of the former typically elicits an immediate response (within 2–4 s), while stimulation of the latter induces a delayed response (8–10s). Localization of GP by high-frequency electrical stimulation can be achieved using a Grass neurostimulator.

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