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Effect of ganglionated plexi ablation by high-density mapping on long-term suppression of paroxysmal atrial fibrillation - The first clinical survey on ablation of the dorsal right plexusus. | LitMetric

AI Article Synopsis

  • This study examines the long-term effects of adding ganglionated plexus (GP) ablation to pulmonary vein isolation (PVI) for patients with paroxysmal atrial fibrillation (PAF).
  • Out of 225 patients analyzed, those who received both GPA and PVI experienced significantly better PAF suppression over four years compared to those who only had the PVI (56.7% vs 38.2%).
  • The findings also indicate that while GPA targeting major GP locations is beneficial, an additional GP ablation at the superior vena cava area does not provide extra benefits in preventing PAF recurrence.

Article Abstract

Background: Long-term outcomes of suppressing paroxysmal atrial fibrillation (PAF) with additive ganglionated plexus (GP) ablation (GPA) remains unknown.

Objectives: The aim of the study is to assess potential role of additional GPA for PAF suppression.

Methods: This study consisted of 225 patients; 68 (group A: 58 male, aged 60 ± 11 years) underwent pulmonary vein isolation (PVI) alone and 157 (group B: 137 male, aged 61 ± 11 years) GPA followed by PVI. GPA was performed based on the high-density mapping with high-frequency stimulation (HFS) delivered to left atrial (LA) major GP. The latter 85 group B patients (54%) underwent ablation to a posteromedial area within superior vena cava as a part of dorsal right atrial GP (SVC-Ao GP).

Results: In group B, HFS was applied to 126 ± 32 sites, with a median of 47 GP sites (40.0%) being ablated. In patients undergoing an SVC-Ao GPA, HFS and the SVC-Ao GPA were applied at a median of 15 and 4 sites (29.4%), respectively. The PVI with a GPA provided higher PAF suppression than a PVI alone during more than 4 years of follow-up (56.7% vs 38.2%, odds ratio: 0.42, 95% confidence interval: 0.23-0.76, < .05), but the SVC-Ao GPA did not provide further suppressive effects. Multivariate analyses revealed that tachycardia-bradycardia syndrome and non-PV foci were independent predictors of PAF recurrence after PVI with a GPA ( < .01).

Conclusion: GPA to LA major GP by high-density mapping provides long-term benefits for PAF suppression over 4 years of follow-up, but the effect of an empiric SVC-Ao GPA could not be appreciated, suggesting little effect on suppressing non-PV foci.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505203PMC
http://dx.doi.org/10.1016/j.hroo.2021.07.002DOI Listing

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