title: Catheter Ablation of Recurrent Paroxysmal Atrial Fibrillation: Is Gap-Closure Combining Ganglionated Plexi Ablation More Effective?
abstract: BACKGROUND
  For repeat treatment with paroxysmal atrial fibrillation (PAF) recurrence, gap-closure at pulmonary vein ostia alone is not enough. Many recent studies indicated that ganglionated plexi (GPs) denervation could reduce the recurrence of AF. However, it is unclear whether the clinical outcomes of additional GP ablation plus pulmonary veins (PVs ) reisolation during a repeat procedure were associated with less recurrence in PAF patients. The purpose of this study was to evaluate if a repeat procedure of GP ablation (GPA) combining repeated procedure of pulmonary vein isolation (re-PVI), i.e., gap-closure, can offer additional benefit for patients with PAF recurrence.
  
  
  METHODS
  A total of 123 consecutive patients with PAF recurrence who underwent success repeat procedures were retrospectively analyzed in our center (2014-2015). Note that 64 patients (group 1, GPA group) were performed with GPA plus re-PVI, while 59 patients (group 2, re-PVI group) had re-PVI (gap-closure) alone. Organized atrial tachycardias (OATs) documented or induced at the end of the procedure were all mapped and ablated. Patients were scheduled for a 12-month follow-up. Clinical presentation and outcome data for the two groups were assessed.
  
  
  RESULTS
  At the 12-month follow-up 58 of 64 patients (90.6%) in group 1 and 46 of 59 patients (78%) in group 2 remained in sinus rhythm (SR) off antiarrhythmia drugs (AADs) (P = 0.045).
  
  
  CONCLUSIONS
  GPA conferred incremental benefit when performed in addition to re-PVI in patients with PAF recurrence; the GPA group yielded higher success rates than the re-PVI group.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.|Department of Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao, China.
authors.forename: Feng-Qiang
authors.identifier: http://orcid.org/0000-0001-9589-9773
authors.initials: FQ
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Rong-Hui
authors.initials: RH
authors.lastname: Yu
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Rong
authors.identifier: http://orcid.org/0000-0002-3106-7318
authors.initials: R
authors.lastname: Bai
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Nian
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Y I
authors.initials: YI
authors.lastname: An
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Xue-Yuan
authors.initials: XY
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Ri-Bo
authors.initials: RB
authors.lastname: Tang
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: DE-Yong
authors.initials: DY
authors.lastname: Long
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Cai-Hua
authors.initials: CH
authors.lastname: Sang
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: DU
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Jian-Zeng
authors.initials: JZ
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Ma
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017763:Autonomic Denervation / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000379:methods* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D005260:Female; D005725:Ganglia, Autonomic / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: catheter ablation; ganglionated plexi; paroxysmal atrial fibrillation; pulmonary vein isolation; recurrence; repeated procedure