18. Mapping of Atrial Repolarization Changes and Tachyarrhythmia Sites of Origin During Activation of Mediastinal Nerve Inputs to the Intrinsic Cardiac Nervous System

  1. Mohammad Shenasa MD3,
  2. Gerhard Hindricks MD4,
  3. Martin Borggrefe MD5,
  4. Günter Breithardt MD6 and
  5. Mark E. Josephson MD7
  1. René Cardinal1 and
  2. Pierre Pagé2

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch18

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Cardinal, R. and Pagé, P. (2013) Mapping of Atrial Repolarization Changes and Tachyarrhythmia Sites of Origin During Activation of Mediastinal Nerve Inputs to the Intrinsic Cardiac Nervous System, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch18

Editor Information

  1. 3

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 4

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 5

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 6

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 7

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. 1

    Centre de recherche, Hôpital du Sacré-Cœur de Montréal, and the Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada

  2. 2

    Centre de recherche, Hôpital du Sacré-Cœur de Montréal, and the Department of Surgery, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • atrial fibrillation;
  • ablation therapy;
  • sinus node atrioventricular node function;
  • atrial refractoriness

Summary

Chronotropic, dromotropic or hypotensive “vagal responses” elicited by high frequency stimulation alone or in combination with anatomic data derived from the literature have been employed to identify juxtacardiac neural targets as adjunct therapy during ablation of myocardial substrates of paroxysmal atrial fibrillation. In particular, attention has been directed to the ganglionated plexuses nested in atrial epicardial fatty tissues as prime targets for ablation. Experimental studies in which atrial tachyarrhythmias were induced by stimulation of the mediastinal nerve inputs to the ganglionated plexuses in canines, show spatial concordance between the tachyarrhythmia sites of origin and the atrial distribution of repolarization changes determined from up to 255 simultaneously recorded unipolar electrograms. Such changes usually occurred in the absence of any chronotropic effect in response to left-sided nerve stimulation. Experimental studies also show that the atrial and ventricular ganglionated plexuses form an interconnected network exerting redundant control over sinus and atrioventricular node function as well as atrial refractoriness. It is concluded that ablative therapy targeting the intrinsic cardiac nervous system in individual patients can hardly be based on a priori anatomic generalizations and that functional measures derived from the entire atrial muscle surfaces (repolarization changes) should be required to identify putative neural targets.