Does ganglionated plexi ablation improve the maintenance of sinus rhythm in patients with symptomatic, drug-refractory, persistent atrial fibrillation?
Ganglionated plexi ablation alone has a modest success rate (38.2%) for maintaining sinus rhythm in longstanding persistent AF, but overall success increases to 59.6% when combined with repeat procedures including pulmonary vein isolation.
AIMS: To study the potential efficacy of ganglionated plexi (GP) ablation in the setting of longstanding persistent atrial fibrillation (AF). METHODS AND RESULTS: Anatomic ablation at the areas of GP in the left atrium was performed in 89 patients with symptomatic, drug-refractory, persistent AF (71 men, 56 +/- 7 years of age). In 29 patients, a second procedure by means of circumferential pulmonary vein (PV) isolation was performed, and 5 of them were subjected to a third circumferential ablation. At 16 +/- 7 months after the final ablation procedure, 53 (59.6%) of the 89 patients were in sinus rhythm in the absence of antiarrhythmic drug therapy, 5 (5.6%) patients had permanent AF, and 31 (34.8%) patients had paroxysmal AF. The long-term success rate for patients who underwent a single ablation procedure with only GP ablation was 38.2% over a follow-up of 24 +/- 3 months. Independent predictors of later arrhythmia recurrences were left atrial diameter HR 1.039 (1.00-1.07), P = 0.028 and duration of AF prior to ablation HR 1.116 (1.02-1.22), P = 0.008. CONCLUSION: Ganglionated plexi ablation in chronic AF results in long-term maintenance of sinus rhythm in 38.2% of cases. Repeat procedures with circumferential isolation of all PV offer a success rate of 59.6% over a follow-up of 16 +/- 7 months.
Pokushalov et al. (Sat,) studied this question.