Ablating ganglionated plexi in addition to pulmonary vein isolation is more effective than either procedure alone in maintaining atrial fibrillation-free survival.
Does ganglionated plexi ablation in addition to pulmonary vein isolation improve atrial fibrillation-free survival in patients with atrial fibrillation?
Ganglionated plexi ablation as an adjunct to pulmonary vein isolation may improve outcomes in atrial fibrillation, though optimal techniques and long-term durability require further refinement.
Circumferential pulmonary vein isolation is the mainstay of atrial fibrillation (AF) ablation, but alternative approaches and techniques have been developed to improve the outcomes. One of these additional ablation targets are ganglionated plexi of the intrinsic cardiac autonomic system that contain a variety of sympathetic and parasympathetic neurons that communicate with the extrinsic cardiac autonomic nervous system. The ganglionated plexi of the heart do not serve as a simple relay station but could modulate the autonomic interaction between the extrinsic and intrinsic cardiac autonomic system. Intrinsic cardiac autonomic nerve activity is an invariable trigger of paroxysmal atrial tachyarrhythmia, including atrial fibrillation. Although multiple studies have shown that ganglionated plexi play an important role in initiating atrial fibrillation, there is no consensus on a standardized protocol for selecting target sites and determining how ganglionated plexi ablation can best be accomplished. Recent clinical trials have demonstrated the feasibility and efficacy of ganglionated plexi ablation in addition to pulmonary vein isolation, but novel technologies and strategies are necessary to improve the current ablation techniques in managing patients with atrial fibrillation. This review focuses on the relationship between atrial ganglionated plexi and atrial fibrillation and the potential benefits and limitations of ganglionated plexi ablation in the management of atrial fibrillation.
Choi et al. (2015) conducted a review in Atrial fibrillation. Ganglionated plexi (GP) ablation vs. Pulmonary vein isolation (PVI) alone was evaluated. Ablating ganglionated plexi in addition to pulmonary vein isolation is more effective than either procedure alone in maintaining atrial fibrillation-free survival.