A Meta‐Analysis of the Comparative Efficacy of Ablation for Atrial Fibrillation with and without Ablation of the Ganglionated Plexi

BACKGROUND: Ganglionated plexi (GP) is claimed to be potentially responsible for atrial fibrillation (AF). The efficacy and safety of GP ablation remains controversial. This meta-analysis aimed to assess the efficacy of procedure with or without ablation of GP. METHODS AND RESULTS: We included controlled clinical trials or randomized controlled trials comparing procedures of GP ablation plus pulmonary vein isolation (PVI), GP ablation plus Maze, or GP ablation alone (experimental arm), with PVI or Maze without GP ablation (control arm). The early episodes of atrial arrhythmia recurrence (early recurrence) and freedom from AF (primary efficacy endpoint) were estimated. Six trials with a total of 342 patients (172 per experimental arm, 170 per control arm) were included in the meta-analysis. Subgroup analysis demonstrated that there was no significant difference in early recurrence between additional GP ablation to PVI or Maze, and PVI or Maze without ablation of GP (P = 0.06). However, early recurrence was significantly higher after GP ablation alone, compared with PVI alone (P = 0.02). Freedom from AF recurrence was significantly improved by additional GP ablation to PVI and Maze, compared with PVI and Maze without ablation of GP (P < 0.01). However, it was significantly aggravated by GP ablation alone, compared with PVI alone (P = 0.006). CONCLUSION: The short and relatively long-term success rate of additional GP ablation to PVI or Maze is superior to PVI or Maze without ablation of GP. GP ablation alone is less effective than PVI alone for the treatment of AF. Future studies are necessary to establish and standardize the targeting sites, endpoints, and methods of GP ablation.