Abstract 12439: Comparison Between Pulmonary Vein Isolation Versus Combination Therapy of Pulmonary Vein Isolation and Ganglionated Plexus Ablation for Atrial Fibrillation
Introduction: Pulmonary vein isolation (PVI) has become the major concept for treating atrial fibrillation (AF) by the effect of elimination of AF trigger as well as treatment of AF substrate around pulmonary vein (PV) antrum. On the other hand, it is reported that ganglionated plexus (GP) induce PV firing, and shorten atrial refractory period, are considered to play a critical role to sustain AF. Therefore combination therapy of PVI + GP ablation is expected strategy beyond PVI. But the efficacy of combination therapy of PVI + GP ablation for AF is not known well.
Methods: Consecutive 139 patients with symptomatic, drug-refractory AF were enrolled in this study to receive PVI from Jun. 2009 to Aug. 2010 (n=78: paroxysmal AF (66), persistent AF (12)) or combination therapy of PVI + GP ablation from Sep. 2010 to Mar. 2011 (n=61: paroxysmal AF (48), persistent AF (13)). For PVI group, all 4 PVs were electrically isolated as confirmed by circular mapping catheter. For PVI + GP ablation group, 5 GP (superior left GP, Marshall tract GP, inferior left GP, anterior right GP, inferior right GP) in left atrium where the vagal response was evoked by high frequency stimulation were ablated until the vagal response was eliminated, and subsequently PVI was done. All cases were performed by using a EnSite electroanatomic mapping system. AF/atrial tachycardia (AT) free rate were evaluated in all patients at 6, 9, 12, 15, 18, 21, and 24 months.
Results: After the single ablation procedure, neither in the case of paroxysmal AF nor persistent AF, AF/AT free rate shows any significantly differences between PVI and PVI + GP ablation in every period, except of 9 months ( paroxysmal AF: PVI vs PVI+GP ablation, 53/66 (80.3%) vs 45/48 (93.8%), P = 0.033).
Conclusions: These data suggest that GP ablation in addition to PVI does not improve single-procedure efficacy significantly in patients with paroxysmal AF and persistent AF.
- © 2013 by American Heart Association, Inc.