During ablation of AF, the LA ganglionated plexuses are specifically

targeted by ablation, as identified by high-frequency stimulation

(rectangular
electrical stimuli delivered at a frequency of 20 to 50 Hz for 5
seconds). Alternatively, ablation of ganglionated plexuses can be
performed
according to their anatomic locations instead of relying on the
parasympathetic response to high-frequency stimulation, since the
anatomic locations of the four major atrial ganglionated plexuses vary
minimally among patients (Fig. 15.52).222
Ablation Technique
High-frequency stimulation is performed in the LA adjacent to the
antral region of the PVs and the region of the LA crux. Once identified,
the location of a ganglionated plexus is tagged on the electroanatomic
map. Generally, the four major LA ganglionated plexuses can be
identified
and localized using high-frequency stimulation in the majority of
patients; though it is not uncommon that one or more ganglionated
plexuses cannot be identified, especially in patients with persistent AF.
RF is delivered after all ganglionated plexus sites have been identified.
RF ablation is usually performed using an irrigated-tip catheter (25
to 35 W for 40 to 60 seconds). RF power and duration are reduced at
sites close to the esophagus (15 to 20 W for 20 to 30 seconds). After
each RF application, high-frequency stimulation is repeated immediately
at the same site. If a positive parasympathetic response is still elicited,
anterior
During ablation of AF, the LA ganglionated plexuses are specifically
targeted by ablation, as identified by high-frequency stimulation
(rectangular
electrical stimuli delivered at a frequency of 20 to 50 Hz for 5
seconds). Alternatively, ablation of ganglionated plexuses can be
performed
according to their anatomic locations instead of relying on the
parasympathetic response to high-frequency stimulation, since the
anatomic locations of the four major atrial ganglionated plexuses vary
minimally among patients (Fig. 15.52).222
 Ablation Technique
High-frequency stimulation is performed in the LA adjacent to the
antral region of the PVs and the region of the LA crux. Once identified,
the location of a ganglionated plexus is tagged on the electroanatomic
map. Generally, the four major LA ganglionated plexuses can be
identified
and localized using high-frequency stimulation in the majority of
patients; though it is not uncommon that one or more ganglionated
plexuses cannot be identified, especially in patients with persistent AF.
RF is delivered after all ganglionated plexus sites have been identified.
RF ablation is usually performed using an irrigated-tip catheter (25
to 35 W for 40 to 60 seconds). RF power and duration are reduced at
sites close to the esophagus (15 to 20 W for 20 to 30 seconds). After
each RF application, high-frequency stimulation is repeated immediately
at the same site. If a positive parasympathetic response is still elicited,
anterior
tion is applied during NSR, AF generally occurs and usually terminates
within seconds or minutes. Repeated stimulation usually results in
sustained AF, at least in patients with a clinical history of AF.
Alternatively, ganglia identification and ablation can be accomplished
by a purely anatomic technique without the need for specific localization
with high-frequency stimulation. The suboptimal sensitivity of
high-frequency stimulation in identifying all LA ganglionated plexuses
can result in partial and nonhomogeneous atrial denervation. In addition,
high-frequency stimulation commonly requires general anesthesia
and carries the risk of repeated induction of AF. The anatomic approach
is based on studies in humans demonstrating that the largest
accumulation
of PV-related cardiac neural structures is localized to the inferior
and posterior surface of the roots of both left and right inferior PVs,
as well as on the anterior surface of the root of the right superior PV.
Target of Ablation
During ablation of AF, the LA ganglionated plexuses are specifically
targeted by ablation, as identified by high-frequency stimulation
(rectangular
electrical stimuli delivered at a frequency of 20 to 50 Hz for 5
 seconds). Alternatively, ablation of ganglionated plexuses can be
performed
according to their anatomic locations instead of relying on the
parasympathetic response to high-frequency stimulation, since the
anatomic locations of the four major atrial ganglionated plexuses vary
minimally among patients (Fig. 15.52).222
Ablation Technique
High-frequency stimulation is performed in the LA adjacent to the
antral region of the PVs and the region of the LA crux. Once identified,
the location of a ganglionated plexus is tagged on the electroanatomic
map. Generally, the four major LA ganglionated plexuses can be
identified
and localized using high-frequency stimulation in the majority of
patients; though it is not uncommon that one or more ganglionated
plexuses cannot be identified, especially in patients with persistent AF.
RF is delivered after all ganglionated plexus sites have been identified.
RF ablation is usually performed using an irrigated-tip catheter (25
to 35 W for 40 to 60 seconds). RF power and duration are reduced at
sites close to the esophagus (15 to 20 W for 20 to 30 seconds). After
each RF application, high-frequency stimulation is repeated immediately
at the same site. If a positive parasympathetic response is still elicited,
anterior