Refining ablation methods to treat atrial fibrillation

The role of left atrial ganglionated plexi sites that trigger pulmonary vein ectopy in the pathogenesis of paroxysmal atrial fibrillation

Atrial fibrillation (AF) is a common heart rhythm disorder that causes palpitations and breathlessness. The condition is caused by abnormal electrical activity originating from the veins that drain into the left atrium. Catheter ablation is a treatment for AF and involves making tiny burns around these veins to electrically disconnect them from the heart. It prevents AF in 50-60% of patients, but the mechanism by which the treatment works is still debated. One view is that the procedure works by inadvertently damaging the nerve endings near the veins (ganglionic plexi) that trigger this abnormal electrical activity. Dr Kanagaratnam and his team at Imperial College London propose that targeting these ganglionic plexi specifically may be an alternative treatment for AF. There are two studies that suggest this approach will work, but these studies were not designed in a way that can be consistently repeated. In this Clinical Research Training Fellowship, the fellow will use techniques that ensure reproducibility to compare ablation of the ganglionic plexi with the current standard approach in 180 people undergoing treatment for atrial fibrillation. This study will help to understand whether ablating the nerves in the heart that cause atrial fibrillation is better than the current standard treatment.