Interaction of Ganglion Plexi during Atrial Fibrillation Ablation in a Patient with Mirror-image Dextrocardia

-Remarkable Vagal Responses during Hotballoon Ablation-

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The ganglion plexi (GPs) location and vagal response during ablation are not well understood in dextrocardia patients. A 75-year old female with dextrocardia underwent pulmonary vein isolation (PVI) using hot-balloon ablation for atrial fibrillation. A vagal response occurred during the left-superior PV ablation, which was suspected due to neural interactions between the atrial GPs and sinus node. 3D-CT revealed the existence of epicardial adipose tissue (EAT) at the PV antrum and an EAT volume reduction after the PVI. In the present case, the neural location and GP connections consisted of a normal anatomy except for being on the opposite side.