Author + information
- Received April 10, 2013
- Revision received May 27, 2013
- Accepted June 2, 2013
- Published online December 17, 2013.
- Demosthenes G. Katritsis, MD, PhD∗∗ (, )
- Evgeny Pokushalov, MD, PhD†,
- Alexander Romanov, MD†,
- Eleftherios Giazitzoglou, MD∗,
- George C.M. Siontis, MD‡,
- Sunny S. Po, MD§,
- A. John Camm, MD‖ and
- John P.A. Ioannidis, MD, DSc¶
- ∗Department of Cardiology, Athens Euroclinic, Athens, Greece
- †Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
- ‡Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- §Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- ‖Cardiac and Vascular Sciences, St. George's, University of London, London, United Kingdom
- ¶Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford University School of Medicine, and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
- ↵∗Reprint requests and correspondence:
Dr. Demosthenes G. Katritsis, Department of Cardiology, Athens Euroclinic, 9 Athanassiadou Street, Athens 11521, Greece.
Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF).
Background Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI.
Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period.
Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered.
Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF. (Circumferential Versus Ganglionated Plexi Ablation for Atrial Fibrillation [AF]; NCT00671905)
- atrial tachycardia
- catheter ablation
- ganglionated plexi
- implantable loop recorder
- paroxysmal atrial fibrillation
- pulmonary vein isolation
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 10, 2013.
- Revision received May 27, 2013.
- Accepted June 2, 2013.
- American College of Cardiology Foundation