Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery - AFACT
The goal of the trial was to evaluate ganglion plexus ablation among patients with long-standing atrial fibrillation.
Contribution to the Literature: The AFACT trial failed to show that ganglion plexus ablation was superior to control at restoring sinus rhythm.
Patients with long-standing atrial fibrillation were randomized to ganglion plexus ablation (n = 117) versus control (n = 123) on top of pulmonary vein isolation and additional left atrial lines via thoracoscopy.
- Total number of enrollees: 240
- Duration of follow-up: 1 year
- Mean patient age: 60 years
- Percentage female: 27%
- Percentage diabetics: 7%
- Mean duration of atrial fibrillation: 4 years
- Patients with long-standing atrial fibrillation, enlarged atria, or failed catheter ablation
- Thoracic radiation therapy
- Left ventricular ejection fraction <35%
- Long-standing persistent atrial fibrillation
The primary outcome, no atrial fibrillation recurrences, was observed in 70.9% of the ganglion plexus group versus 68.4% of the control group (p = 0.70).
- Total procedure-related adverse events: 19% in the ganglion plexus group versus 8% in the control group (p = 0.022)
- Bleeding: 8% in the ganglion plexus group versus 0 in the control group (p = 0.001)
- Pacemaker implantation: 5% in the ganglion plexus group versus 0 in the control group (p = 0.013)
Among patients with long-standing atrial fibrillation, ganglion plexus block was unsuccessful at achieving a higher frequency of freedom from atrial fibrillation in addition to pulmonary vein isolation. Ganglion plexus block was associated with a higher frequency of bleeding, permanent pacemaker implantation, and total procedure-related adverse events.
Driessen AH, Berger WR, Krul SP, et al. Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study. J Am Coll Cardiol 2016;68:1155-65.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Cardiac Surgical Procedures, Catheter Ablation, Heart Conduction System, Hemorrhage, Pacemaker, Artificial, Pulmonary Veins, Secondary Prevention, Thoracoscopy
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