title: Is ganglionated plexi ablation during Maze IV procedure beneficial for postoperative long-term stable sinus rhythm?
abstract: BACKGROUND
  We investigated the role of surgical ablation targeting the autonomous nervous system during a Cox-Maze IV procedure in the maintenance of sinus rhythm at long-term follow-up.
  
  
  METHODS
  The patient population consisted of 519 subjects with persistent or long-standing persistent atrial fibrillation (AF) undergoing radiofrequency Maze IV during open heart surgery between January 2006 and July 2013 at three institutions without (Group 1) or with (Group 2) ganglionated plexi (GP) ablation. Recurrence of atrial fibrillation off-antiarrhythmic drugs was the primary outcome. Predictors of AF recurrence were evaluated by means of competing risk regression. Median follow-up was 36.7 months.
  
  
  RESULTS
  The percentage of patients in normal sinus rhythm (NSR) off-antiarrhythmic drugs did not differ between groups (Group 1-75.5%, Group 2-67.8%, p = 0.08). Duration of AF ≥ 38 months (p = 0.01), left atrial diameter ≥ 54 mm (0.001), left atrial area ≥ 33 cm(2) (p = 0.005), absence of connecting lesions (p= 0.04), and absence of right atrial ablation (p < 0.001) were independently associated with high incidence of AF recurrence. In contrast the absence of GP ablation was not a significant factor (p = 0.12).
  
  
  CONCLUSIONS
  GP ablation did not prove to be beneficial for postoperative stable NSR. A complete left atrial lesion set and biatrial ablation are advisable for improving rhythm outcomes. Randomized controlled trials are necessary to confirm our findings.
authors.affiliation: University Hospital Maastricht, The Netherlands; Careggi Hospital, Florence Italy. Electronic address: sandro.gelsomino@maastrichtuniversity.nl.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: University Hospital Maastricht, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Lozekoot
authors.affiliation: University Hospital Maastricht, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: La Meir
authors.affiliation: University Hospital Maastricht, The Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: University Hospital Maastricht, The Netherlands; Careggi Hospital, Florence Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.affiliation: Careggi Hospital, Florence Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Rostagno
authors.affiliation: University of Magna Graecia, Catanzaro, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
authors.affiliation: University Hospital Maastricht, The Netherlands; Careggi Hospital, Florence Italy.
authors.forename: Orlando
authors.initials: O
authors.lastname: Parise
authors.affiliation: University Hospital Maastricht, The Netherlands; Careggi Hospital, Florence Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Matteucci
authors.affiliation: Careggi Hospital, Florence Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: University Hospital Maastricht, The Netherlands.
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crjins
authors.affiliation: University Hospital Maastricht, The Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods; D001341:Autonomic Nervous System / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000294:innervation*; D011184:Postoperative Period; D012189:Retrospective Studies
keywords: Ablation; Atrial fibrillation; Mitral valve surgery