049 The role of the neural networks in identification and ablation of pulmonary vein ectopic triggers

IntroductionThe cardiac neural network comprises ganglionated plexi (GP) adjacent to each pulmonary vein (PV) which can trigger AV block and PV ectopy. We hypothesised that AV block in response to GP stimulation is mediated through the right lower GP (RLGP) and could be abolished by ablation of the RLGP, whereas a local PV ectopy response could be abolished by selective local GP ablation.Methods and Results10 patients undergoing left atrial (LA) ablation with autonomic modification were recruited. Continuous HFS was delivered endocardially at presumed GP sites using a Grass Stimulator (20 Hz, 10 ms pulse duration, 10 V). GP sites with connections to the AV node (producing AV block) were marked on LA geometry. RLGP group (N=5) had RF ablation of RLGP and 2 of 15 sites remained positive (p