Abstract 12742: Anatomic Ganglionated Plexi Ablation is Inferior to Circumferential Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation: a Three-year Follow-up Study
Introduction: A new strategy for anatomically-based ganglionated plexi (GP) ablation for the treatment of paroxysmal atrial fibrillation (AF) has been proposed recently. High success rate of this approach during one-year follow-up period has been reported. We assessed the hypothesis that the long-term results of anatomic GP ablation remain good.
Methods: The study population consisted of 70 patients (mean age 56.6±10.9 years; 41 males) with paroxysmal AF and no history of structural heart disease: 35 subjects underwent anatomic GP ablation; and 35 patients undergoing circumferential PV isolation (CPVI) at the same period comprised the control group. The groups were not different according to a number of clinical parameters (age, left atrial diameter, presence of hypertension, diabetes and others).
Results: Anatomic GP ablation required more ablation points (85.6±5.5 vs. 74.4±6.2, p<0.05) and equal duration of total procedure (154±18 vs. 147±19 min, p=ns) and fluoroscopy time (35.4±17.3 vs. 34.5±13.5 min, p=ns). During a mean follow-up period of 36.3±2.3 months, free from any atrial tachyarrhythmia without antiarrhythmics were 34.3% patients after anatomic GP ablation and 65.7% patients after CPVI (log-rank test p=0.008, Figure). Early arrhythmia episodes and stand-alone anatomic GP ablation were independent predictors of late recurrence: HR 6.44 (CI 95%; 3.14–13.18; p<0.001) and HR 2.08 (CI 95%; 1.03–4.22; p=0.04), respectively. Six patients in the group of GP ablation underwent subsequent CPVI, plus perimitral flutter ablation in 2 of them. No further recurrences developed in 5 of these patients.
Conclusions: Anatomic GP ablation yields a significantly lower success rate over the long-term follow-up period, as compared to CPVI. Recurrences include AF and macro re-entrant atrial tachycardias.
- © 2010 by American Heart Association, Inc.