Ganglionated plexi ablation for longstanding persistent atrial fibrillation.
OBJECTIVE
To study the potential efficacy of ganglionated plexi (GP) ablation in the setting of longstanding persistent atrial fibrillation (AF).


RESULTS
Anatomic ablation at the areas of GP in the left atrium was performed in 89 patients with symptomatic, drug-refractory, persistent AF (71 men, 56 +/- 7 years of age). In 29 patients, a second procedure by means of circumferential pulmonary vein (PV) isolation was performed, and 5 of them were subjected to a third circumferential ablation. At 16 +/- 7 months after the final ablation procedure, 53 (59.6%) of the 89 patients were in sinus rhythm in the absence of antiarrhythmic drug therapy, 5 (5.6%) patients had permanent AF, and 31 (34.8%) patients had paroxysmal AF. The long-term success rate for patients who underwent a single ablation procedure with only GP ablation was 38.2% over a follow-up of 24 +/- 3 months. Independent predictors of later arrhythmia recurrences were left atrial diameter [HR 1.039 (1.00-1.07), P = 0.028] and duration of AF prior to ablation [HR 1.116 (1.02-1.22), P = 0.008].


CONCLUSIONS
Ganglionated plexi ablation in chronic AF results in long-term maintenance of sinus rhythm in 38.2% of cases. Repeat procedures with circumferential isolation of all PV offer a success rate of 59.6% over a follow-up of 16 +/- 7 months.
Pokushalov
Evgeny
E
Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia. e.pokushalov@gmail.com
Romanov
Alexander
A
Artyomenko
Sergey
S
Turov
Alex
A
Shugayev
Pavel
P
Shirokova
Natalya
N
Katritsis
Demosthenes G
DG
D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005725:Ganglia, Autonomic / Q000601:surgery*; D006321:Heart / Q000294:innervation*; D006325:Heart Atria / Q000294:innervation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D055502:Secondary Prevention; D016896:Treatment Outcome