title: Left atrial ganglion ablation as an adjunct to atrial fibrillation surgery in valvular heart disease.
abstract: BACKGROUND
  Our aim was to evaluate early results of ganglionic plexus (GP) ablation with modified Cox maze lesion sets for concomitant atrial fibrillation (AF) during corrective valve surgery.
  
  
  METHODS
  Between December 2006 and April 2008, 20 patients (7 men; median age, 65 years; range, 52 to 82 years) with valvular heart disease and AF (intermittent in 12 [60%]) underwent corrective valve surgery with maze and GP ablation. Patients were then compared with a case-matched control cohort who underwent radiofrequency ablation maze alone.
  
  
  RESULTS
  Procedures included mitral valve repair in 7 patients (35%), multivalve procedures in 5 (25%), mitral valve replacement in 4 (20%), aortic valve replacement in 3 (15%), and valve-sparing aortic root replacement in 1 (5%). All patients underwent concomitant AF ablation procedures (biatrial maze in 11 [55%], left-sided maze in 9 [45%]). Ganglionic plexus stimulation was performed in all patients. Sites at which the R-R interval doubled were considered active and were ablated. There were no early deaths. Freedom from AF at 1 year was significantly higher (90% versus 50%; p=0.01) and mean New York Heart Association functional class was better (1 versus 1.7; p<0.001) in the group that underwent maze and GP ablation compared with maze alone.
  
  
  CONCLUSIONS
  Active left atrial GP are frequently present in patients with AF and valvular heart disease, and GP ablation can be safely performed as an adjunct to AF ablation during valve surgery. Early results are promising and may yield higher freedom from AF compared with radiofrequency ablation maze alone.
authors.affiliation: Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Ware
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D005724:Ganglia; D006325:Heart Atria / Q000294:innervation; D006349:Heart Valve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D012189:Retrospective Studies; D016896:Treatment Outcome