title: Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison.
abstract: BACKGROUND
  The optimal ablation technique for persistent and long-standing persistent atrial fibrillation (AF) is unclear. Both linear lesion (LL) and ganglionated plexus (GP) ablation have been used in addition to pulmonary vein isolation (PVI), but no direct comparison of the 2 methods exists.
  
  
  OBJECTIVE
  The aim of this study is to assess the comparative safety and efficacy of 2 different ablation strategies-PVI+LL vs PVI+GP ablation -in patients with persistent or long-standing persistent AF.
  
  
  METHODS
  Two hundred sixty-four consecutive patients with persistent/long-standing persistent AF were randomly assigned to 2 different ablation schemes: PVI+LL (n = 132) and PVI+GP (n = 132) ablation. Consistent sinus rhythm (SR) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device.
  
  
  RESULTS
  All procedural end points were acutely achieved. At 12 months after a single procedure, 47% of the patients treated with PVI+LL were in SR compared to 54% of the patients treated with PVI+GP (P = .29). At 3 years, 34% of the patients with PVI+LL and 49% of the patients with PVI+GP maintained SR (P = .035). Atrial flutter was more frequent in the PVI+LL group than in PVI+GP group (18% vs 6%; P = .002). After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group, the long-term overall success rate was 52% and 68%, respectively (P = .006).
  
  
  CONCLUSIONS
  PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL ablation at 3 years of follow-up.
authors.affiliation: Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia. E.Pokushalov@gmail.com
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
authors.forename: Alexandr
authors.initials: A
authors.lastname: Romanov
authors.forename: Demosthenes G
authors.initials: DG
authors.lastname: Katritsis
authors.forename: Sergey
authors.initials: S
authors.lastname: Artyomenko
authors.forename: Natalya
authors.initials: N
authors.lastname: Shirokova
authors.forename: Alexandr
authors.initials: A
authors.lastname: Karaskov
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: AF; Ablation; Atrial fibrillation; Autonomic nervous system; CFAE; ECG; GP; Ganglionated plexus; HFS; IMD; LA; LL; PV; PVI; RF; SR; atrial fibrillation; complex fractionated atrial electrogram; electrocardiogram; ganglionated plexus; high-frequency stimulation; implanted monitoring device; left atrial/atrium; linear lesion; pulmonary vein; pulmonary vein isolation; radiofrequency; sinus rhythm