Abstract 12346: Additional Ganglionated Plexi Ablation Prevents Immediate Atrial Fibrillation Recurrence After Left Atrial Catheter Ablation
Background: Immediate recurrence of atrial fibrillation (AF) is one of the common problems after radiofrequency catheter ablation (RFCA) for AF. Now we investigated whether ganglionated plexi (GP) ablation could reduce immediate AF recurrence compared to left atrial (LA) catheter ablation alone.
Methods: Among the consecutive patients with drug-resistant AF, 30 patients underwent LA ablation without GP ablation (LA ablation alone) and 30 patients underwent LA ablation with GP ablation (LA+GP ablation). GP ablation was done before LA ablation. LA ablation includes pulmonary vein isolation (PVI) and complex fractionated atrial electrogram (CFAE) ablation. In GP ablation, the points where R-R interval became 1.5 times as baseline by high frequency stimulation (HFS; 20 Hz, 20 V, less than 5 seconds) from ablation catheter were given radiofrequency energy until the responses disappeared. HFSs were given at the five major GP at least five times each GP.
Results: There was no difference between the patients with LA ablation alone and those with LA+GP ablation in terms of the age, gender, BNP level, prevalence of CFAE ablation. There was no complication. Immediate AF recurrence, defined as supra-ventricular arrhythmia more than 5 minutes within 3-day after RFCA, frequently occurred in patients with LA ablation alone [53% (n=16)] compared to those with LA+GP ablation [17% (n=5)] (P=0.003). Univariate analysis revealed that GP ablation [hazard ratio (HR) 0.175, 95% confidential interval (CI) 0.0528 - 0.580, p=0.004] and left ventricular ejection fraction (HR 0.901, 95% CI 0.827 - 0.995, p= 0.038) were significantly associated with the risk of immediate AF recurrence. Multivariable analysis revealed that GP ablation was the only independent predictor to prevent during 3-day immediate after RFCA (HR 0.184, 95% CI 0.0524 to 0.648, p = 0.0084).
Conclusions: Additional GP ablation decreased immediate AF recurrence after RFCA and may simplify postoperative management.
- © 2013 by American Heart Association, Inc.