Stepwise modulation of the cardiac neural network during ablation at the left superior pulmonary vein-atrial junction

Abstract

We report a case of a 61-year-old man with vagal-induced atrial fibrillation who was referred to our institution for radiofrequency ablation. Ablation at the left superior pulmonary vein-atrial junction was accompanied by heart rate slowing and PR interval prolongation. This parasympathetic response resulted in a prolonged sinus arrest and a subsequent third-degree atrioventricular (AV) block. Additional ablation was accompanied by a second-degree AV block followed by selective PR prolongation before the parasympathetic response was abolished. Our findings support experimental evidence, indicating that the superior left ganglionated plexus functions as an integration centre within the neural network modulating sinoatrial and AV node control. © The Author 2010.