Anatomic ganglionated plexi ablation resulted in a significantly lower rate of freedom from atrial tachyarrhythmia compared to circumferential pulmonary vein isolation (34.3% vs 65.7%, P=0.008).
Cohort (n=70)
Does anatomic ganglionated plexi ablation improve freedom from atrial tachyarrhythmia compared to circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
Anatomic ganglionated plexi ablation yields a significantly lower long-term success rate for maintaining sinus rhythm compared to standard circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
Effect estimate: HR 2.08 (95% CI 1.03-4.22)
Absolute Event Rate: 34.3% vs 65.7%
p-value: p=0.008
AIMS: A new strategy for anatomically based ganglionated plexi (GP) ablation for the treatment of paroxysmal atrial fibrillation (AF) has been proposed recently. We aimed to assess the long-term outcome of patients undergoing anatomic GP ablation for paroxysmal AF, in comparison with circumferential pulmonary vein (PV) isolation. METHODS AND RESULTS: The study population consisted of 70 patients (mean age 56.6 ± 10.9 years; 41 males) with paroxysmal AF and no history of structural heart disease: 35 subjects underwent anatomic GP ablation, while 35 consecutive patients had circumferential PV isolation (CPVI) (control group). The groups were not different in demographic and clinical parameters. Anatomic GP ablation required more ablation points (85.6 ± 5.5 vs. 74.4 ± 6.2, P < 0.05) and equal duration of total procedure and fluoroscopy times. During a mean follow-up period of 36.3 ± 2.3 months, freedom from any atrial tachyarrhythmia without antiarrhythmics was achieved in 34.3% patients after anatomic GP ablation and 65.7% patients after CPVI (log-rank test P = 0.008). Early arrhythmia recurrences and anatomic GP ablation were independent predictors of late recurrence HR 6.44 (CI 95%; 3.14-13.18; P < 0.001) and HR 2.08 (CI 95%; 1.03-4.22; P = 0.04), respectively. Six patients in the group of GP ablation underwent subsequent CPVI, plus peri-mitral flutter ablation in two of them, with no further arrhythmia episodes in five patients. CONCLUSION: Anatomic GP ablation yields a significantly lower success rate over the long-term follow-up period, when compared with CPVI. Recurrences include AF and macro re-entrant atrial tachycardias.
Mikhaylov et al. (Wed,) conducted a cohort in paroxysmal atrial fibrillation (n=70). anatomic ganglionated plexi (GP) ablation vs. circumferential pulmonary vein isolation (CPVI) was evaluated on freedom from any atrial tachyarrhythmia without antiarrhythmics (HR 2.08, 95% CI 1.03-4.22, p=0.008). Anatomic ganglionated plexi ablation resulted in a significantly lower rate of freedom from atrial tachyarrhythmia compared to circumferential pulmonary vein isolation (34.3% vs 65.7%, P=0.008).