Choi Eue-Keun, Chen Peng-Sheng
Seoul National University Hospital, Seoul, Republic of Korea.
Indiana University School of Medicine, Indianapolis, Indiana.
Methodist Debakey Cardiovasc J. 2015 Apr-Jun;11(2):82-6. doi: 10.14797/mdcj-11-2-82.
Circumferential pulmonary vein isolation is the mainstay of atrial fibrillation (AF) ablation, but alternative approaches and techniques have been developed to improve the outcomes. One of these additional ablation targets are ganglionated plexi of the intrinsic cardiac autonomic system that contain a variety of sympathetic and parasympathetic neurons that communicate with the extrinsic cardiac autonomic nervous system. The ganglionated plexi of the heart do not serve as a simple relay station but could modulate the autonomic interaction between the extrinsic and intrinsic cardiac autonomic system. Intrinsic cardiac autonomic nerve activity is an invariable trigger of paroxysmal atrial tachyarrhythmia, including atrial fibrillation. Although multiple studies have shown that ganglionated plexi play an important role in initiating atrial fibrillation, there is no consensus on a standardized protocol for selecting target sites and determining how ganglionated plexi ablation can best be accomplished. Recent clinical trials have demonstrated the feasibility and efficacy of ganglionated plexi ablation in addition to pulmonary vein isolation, but novel technologies and strategies are necessary to improve the current ablation techniques in managing patients with atrial fibrillation. This review focuses on the relationship between atrial ganglionated plexi and atrial fibrillation and the potential benefits and limitations of ganglionated plexi ablation in the management of atrial fibrillation.
环肺静脉隔离是心房颤动（AF）消融的主要手段，但已开发出其他方法和技术来改善治疗效果。这些额外的消融靶点之一是心脏固有自主神经系统的神经节丛，其包含多种与心脏外在自主神经系统通信的交感和副交感神经元。心脏的神经节丛并非简单的中继站，而是可以调节心脏外在和固有自主神经系统之间的自主神经相互作用。心脏固有自主神经活动是阵发性房性快速心律失常（包括心房颤动）的不变触发因素。尽管多项研究表明神经节丛在引发心房颤动中起重要作用，但对于选择靶点部位和确定如何最佳完成神经节丛消融的标准化方案尚无共识。近期临床试验已证明除肺静脉隔离外，神经节丛消融的可行性和有效性，但需要新技术和策略来改进当前用于治疗心房颤动患者的消融技术。本综述重点关注心房神经节丛与心房颤动之间的关系以及神经节丛消融在心房颤动管理中的潜在益处和局限性。
