Ectopy-triggering ganglionated plexuses ablation to prevent atrial fibrillation: GANGLIA-AF study

Area of Science:

• Cardiology
• Electrophysiology
• Autonomic Nervous System

Background:

• The ganglionated plexuses (GPs) are integral to the intrinsic cardiac autonomic system.
• These GPs may influence the pathophysiology of atrial fibrillation (AF).

Purpose of the Study:

• To test the hypothesis that ablating ectopy-triggering GPs (ET-GPs) can prevent AF.
• To compare the efficacy of GP ablation (GPA) versus pulmonary vein isolation (PVI) in paroxysmal AF patients.

Main Methods:

• A prospective, randomized, controlled trial (GANGLIA-AF) involving 102 patients.
• ET-GPs were identified via high-frequency stimulation and ablated; atrioventricular dissociating GPs were ablated if AF persisted.
• Patients were randomized to either GPA without pulmonary vein isolation (PVI) or PVI alone, with 12-month follow-up using Holter monitors.

Main Results:

• Freedom from atrial arrhythmia at 12 months was 50% with GPA versus 64% with PVI (P = .09).
• GPA involved significantly less radiofrequency ablation time (22.9 min vs 38 min; P < .0001).
• A significantly higher reduction in antiarrhythmic drug usage was observed after GPA compared to PVI (55.5% vs 36%; P = .05).

Conclusions:

• GP ablation (GPA) was not superior to pulmonary vein isolation (PVI) in preventing atrial arrhythmias.
• GPA demonstrated a significant reduction in antiarrhythmic drug use and required less ablation time compared to PVI.