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PURPOSE: Adjunctive ganglionated plexi (GP) ablation may improve success rates for treatment of atrial fibrillation (AF) when combined with pulmonary vein (PV) isolation. Existing meta-analyses on GP ablation have included observational studies and have not incorporated more recent randomized clinical trial data. Moreover, the impact of AF subtype (paroxysmal vs. persistent) on outcomes of GP ablation has not been well established. METHODS: We performed a meta-analysis of randomized controlled trials (RCTs) comparing GP ablation + pulmonary vein (PV) isolation versus PV isolation alone according to the subtype of AF. The primary endpoint was freedom from sustained AF or atrial tachyarrhythmia (AT) after a single procedure. RESULTS: Across four RCTs, 718 patients (358 and 360 that underwent GP ablation + PV isolation [intervention] vs. PV isolation alone [control], respectively) were included in the study. Mean left atrial size and left ventricular ejection fraction were 45.7 mm and 54.8%, respectively. Among paroxysmal AF patients, GP ablation was linked to significantly higher freedom from AT/AF (75.8 vs. 60.0% for the intervention vs. control arms respectively; OR [95% CI]: 2.22 [1.36-3.61], P = 0.001). Among persistent AF patients, GP ablation was associated with a non-significant trend towards higher rates of freedom from AT/AF (54.7 vs. 43.3% for the intervention vs. control arms respectively; OR [95% CI]: 1.55 [0.96-2.52], P = 0.08). In all cases, heterogeneity was found to be low (I 2 of 32% or lower). CONCLUSIONS: Compared to PV isolation alone, GP ablation + PV isolation is associated with better outcomes in patients with paroxysmal AF and without significant structural heart disease.

Original publication

DOI

10.1007/s10840-017-0285-z

Type

Journal article

Journal

J Interv Card Electrophysiol

Publication Date

12/2017

Volume

50

Pages

253 - 260

Keywords

Atrial fibrillation, Catheter ablation, Ganglionated plexi, Pulmonary vein isolation, Aged, Atrial Fibrillation, Autonomic Denervation, Catheter Ablation, Female, Ganglia, Autonomic, Humans, Male, Middle Aged, Pulmonary Veins, Randomized Controlled Trials as Topic, Recurrence, Risk Assessment, Survival Analysis, Tachycardia, Paroxysmal, Treatment Outcome