Despite progress made in treating atrial fibrillation with catheter ablation, outcomes remain suboptimal with pulmonary vein isolation alone. Ablation of ganglionated plexi (GP) has been shown to be beneficial in patients with atrial fibrillation although optimal strategies of localization of these regions have yet to be determined. The investigators aim to develop a novel strategy of CT guided GP localization to guide ablation in patients with atrial fibrillation. The investigators also aim to clarify the network of innervation between GP to clarify the optimal ablation strategy. This is an observational, single-center study evaluating feasibility and efficacy of CT and high frequency stimulation (HFS) guided GP mapping and ablation in patients with AF undergoing catheter ablation with pulmonary vein isolation. Patients will undergo HFS and CT guided mapping of GPs followed by allocation into one of 8 different GP ablation approaches in a non-randomized fashion.
Study Type
OBSERVATIONAL
Enrollment
30
Ganglionated plexi will be mapped using high frequency stimulation with standard ablation catheters attached to a Natus Cortical Stimulator for high frequency stimulation. Vagal innervation to the heart will be assessed with non-invasive Parasym tragal stimulation.
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Correlation Between HFS (High Frequency Stimulation) Response and CT Identified Epicardial Adipose Tissue.
Number of patients with HFS response identified within 3 pixels (0.625x3=1.875mm) of a location where CT identified epicardial adipose tissue.
Time frame: During Procedure
HFS (High Frequency Stimulation) Response Elimination
Elimination of local of HFS response following GP ablation
Time frame: during procedure
Global Vagal Response Elimination
Elimination of global vagal response to non-invasive tragal stimulation
Time frame: This will be assessed during the procedure.
Ablation Site Changes - Amplitude of Signals
Characterization of amplitude signals at sites with HFS responses and successful HFS elimination
Time frame: This will be assessed during the procedure.
Ablation Site Changes - Duration of Signals
Characterization of duration of signals at sites with HFS responses and successful HFS elimination
Time frame: This will be assessed during the procedure.
Ablation Site Changes - Fractionation of Signals
Characterization of fractionation of signals at sites with HFS responses and successful HFS elimination
Time frame: This will be assessed during the procedure.
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