Catheter Ablation of Right Atrial Ganglionated Plexi in Patients With Vagal Paroxysmal Atrial Fibrillation
Does radiofrequency catheter ablation (RFCA) of right atrial (RA) ganglionated plexi (GP) eliminate vagotonic atrial fibrillation (AF)?
Thirty-four patients (mean age 49 years) with vagotonic paroxysmal AF were randomly assigned to undergo selective RFCA of RA GP guided by high-frequency stimulation (HFS) at the posterior and septal right atrium (n = 17) or anatomic ablation at known RA GP sites on the posterior wall and near the superior vena cava and coronary sinus ostium. Serial 24-hour Holter monitoring with assessment of heart rate variability (HRV) was performed during follow-up. The primary endpoint was freedom from AF/flutter.
In the selective GP ablation group, a mean of six RA GP sites were identified by a vagal response to HFS, and the vagal responses were successfully abolished by RFCA using a mean of 21 minutes of RF energy. In the anatomic GP ablation group, a mean of 39 minutes of RF energy was delivered at key RA sites. The mean duration of follow-up was 20 months. Freedom from AF/flutter at 1 year was significantly lower in the selective ablation group (35%) than in the anatomic ablation group (88%). At 2 years, freedom from AF was 35% versus 70% in the two groups, respectively. HRV parameters were consistent with parasympathetic denervation that was more prominent among patients in the anatomic ablation group and in patients with a successful clinical outcome.
The authors concluded that anatomic RFCA of RA GP often eliminates vagotonic paroxysmal AF.
The elimination of vagotonic AF without any pulmonary vein isolation provides strong evidence of a major role for RA GP in the pathogenesis of this type of AF.
Keywords: Follow-Up Studies, Coronary Sinus, Pulmonary Veins, Parasympathectomy, Electrocardiography, Autonomic Pathways, Heart Rate, Catheter Ablation, Atrial Flutter, Vena Cava, Superior
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