Rapid Pulmonary Vein Isolation Combined With Autonomic Ganglia Modification: A Randomized Study

Study Questions:

Does ablation of ganglionated plexi (GP) improve outcomes when added to pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF)?

Methods:

Sixty-seven patients (mean age 54 years) with paroxysmal AF were randomly assigned to undergo PVI (n = 33) or PVI plus GP ablation. PVI was performed with a 10-pole circular-array ablation catheter using bipolar and unipolar radiofrequency energy. Anatomic GP ablation was performed with a conventional, irrigated-tip radiofrequency ablation catheter guided by an electroanatomic map of the left atrium. The left superior, right anterior, left inferior, and right inferior GPs were targeted based on their presumed locations relative to the PVs. A 48-hour Holter monitor was obtained every 3 months during follow-up. The primary endpoint was freedom from AF at 3-12 months after 1-2 ablation procedures.

Results:

The mean duration of follow-up was approximately 1 year. The redo ablation rate was 21% in the PVI group and 18% in the PVI plus GP ablation group. After two procedures, freedom from AF was significantly higher in the PVI plus GP ablation group (85%) than in the PVI group (61%).

Conclusions:

The authors concluded that adjunctive GP ablation improves outcomes when added to PVI in patients with paroxysmal AF.

Perspective:

Prior studies on the clinical value of GP ablation have reported conflicting results. Although this study was small, it was well-designed and executed, and substantially strengthens the case for GP ablation. Because the major GPs are located in close proximity to the PVs, antral PVI probably often modifies the GPs, perhaps explaining why antral PVI is more effective than ostial PVI in patients with paroxysmal AF.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Heart Atria, Follow-Up Studies, Pulmonary Veins, Electrocardiography, Ambulatory, Catheter Ablation, Ganglia, Autonomic


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