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.

Study Design

  • Randomized
  • Parallel

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

Inclusion criteria:

  • Patients with long-standing atrial fibrillation, enlarged atria, or failed catheter ablation

Exclusion criteria:

  • Thoracic radiation therapy
  • Left ventricular ejection fraction <35%
  • Long-standing persistent atrial fibrillation

Principal Findings:

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).

Secondary outcomes:

  • 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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