Active Ganglionated Plexi Is a Predictor of Atrial Fibrillation Recurrence After Minimally Invasive Surgical Ablation

BACKGROUND AND AIM: Ganglionated plexi (GP) ablation has been become an important strategy for treating atrial fibrillation (AF). We hypothesize that active GP is a predictor of AF recurrence after minimally invasive surgical AF ablation. METHODS: Eighty-nine patients with symptomatic lone AF undergoing minimally invasive surgical pulmonary vein isolation combined with GP testing and ablations were followed for a median of 50 months. Success was defined as freedom from any atrial tachyarrhythmia lasting >30 seconds duration. RESULTS: The single-procedure success rate is 56.3% for paroxysmal AF, 27.3% for persistent AF, and 25% for long-term persistent AF. A mean of 4.1 active GPs were identified in each patient. There were more active GP on the right side than on the left side (2.8 ± 2.2 vs. 1.4 ± 1.2, p<0.001). The number of active GP independently predicted recurrence of AF at 12 months (hazard ratios [95% CI]: 0.67 [0.48, 0.95]; p=0.022), 24 months (0.71 [0.53, 0.95]; p=0.019), and 60 months (0.69 [0.54, 0.89]; p=0.004). Patients with active GP above 5 were associated with higher long-term success rates in comparison to patients with less active GP (p=0.014). Duration of AF >24 months, early recurrence of AF, and left atrial diameter also predicted long-term recurrences of AF. CONCLUSIONS: The number of active GP is a predictor of AF recurrence after minimally invasive surgical AF ablation. Patients with more active GP were associated with markedly higher single-procedure success rates.