Selective ganglionated plexi ablation for paroxysmal atrial fibrillation.
BACKGROUND
Selective ganglionated plexi (GP) ablation guided by high-frequency stimulation has been proposed for the treatment of paroxysmal atrial fibrillation (AF), but the efficacy of the method is not established.


OBJECTIVE
This study sought to compare selective ablation of GP identified by high-frequency stimulation with extensive regional ablation targeting the anatomic areas of GP in patients with paroxysmal AF.


METHODS
Eighty patients with paroxysmal AF (age 53 +/- 9 years) were randomized to undergo selective GP ablation or regional left atrial ablation at the anatomic sites of GP. For selective GP ablation (n = 40), ablation targets were the sites where vagal reflexes were evoked by high-frequency stimulation. Vagal reflexes were defined as prolongation of the R-R interval by >50% and a concomitant decrease in blood pressure (>20 mm Hg) during AF. The end point of the procedure was failure to reproduce vagal reflexes with repeated high-frequency stimulation. For anatomic ablation, lesions were delivered at the sites of GP clustering.


RESULTS
At 13.1 +/- 1.9 months, 42.5% of patients with selective GP and 77.5% of patients with anatomic ablation were free of symptomatic paroxysmal AF (PAF) (P = .02). Parasympathetic denervation was more prominent in patients with anatomic than selective GP ablation, and in patients free of AF compared to these with AF recurrence immediately after ablation, but this trend was abolished at 6 months.


CONCLUSIONS
Selective GP ablation directed by high-frequency stimulation does not eliminate paroxysmal AF in the majority of patients. An anatomic approach for regional ablation at the sites of GP confers better results.
Pokushalov
Evgeny
E
Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Romanov
Alex
A
Shugayev
Pavel
P
Artyomenko
Sergey
S
Shirokova
Natalya
N
Turov
Alex
A
Katritsis
Demosthenes G
DG
D001281:Atrial Fibrillation / Q000601:surgery*; D017776:Autonomic Pathways / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria / Q000294:innervation / Q000601:surgery*; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D036542:Tomography, Spiral Computed; D014628:Vagotomy / Q000295:instrumentation / Q000379:methods*; D014630:Vagus Nerve / Q000601:surgery*