Ganglionated plexi ablation for longstanding persistent atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Interventions

Background:

• Persistent atrial fibrillation (AF) poses a significant clinical challenge, often requiring advanced treatment strategies.
• Ganglionated plexi (GP) are autonomic nerve clusters implicated in AF pathophysiology.
• Understanding the efficacy of targeting GPs is crucial for improving AF management.

Purpose of the Study:

• To evaluate the effectiveness of ganglionated plexi (GP) ablation for treating longstanding persistent atrial fibrillation (AF).
• To determine the long-term success rates of single-procedure GP ablation versus repeat procedures involving pulmonary vein (PV) isolation.

Main Methods:

• Eighty-nine patients with symptomatic, drug-refractory persistent AF underwent anatomical GP ablation.
• A subset of patients (29) received subsequent circumferential pulmonary vein (PV) isolation, with 5 undergoing a third ablation procedure.
• Outcomes were assessed at 16 ± 7 months post-ablation, with a subset followed for 24 ± 3 months.

Main Results:

• Following GP ablation alone, 38.2% of patients maintained sinus rhythm long-term.
• After repeat procedures including PV isolation, the success rate increased to 59.6% at 16 ± 7 months.
• Left atrial diameter and duration of AF were independent predictors of recurrence.

Conclusions:

• Ganglionated plexi ablation alone achieves long-term sinus rhythm in 38.2% of patients with chronic AF.
• Repeat procedures incorporating circumferential PV isolation significantly enhance success rates to 59.6%.