Ganglionated plexi ablation impact on AF mechanisms and outcomes in patients with low scar burden
Year: 2025
Type: article
Abstract: AIMS: Persistent atrial fibrillation (AF) ablation success rates remain limited. The aim was to evaluate the impact of ganglionated plexi (GP) ablation on AF mechanisms and outcomes in patients with low scar burden. METHODS AND RESULTS: Patients undergoing persistent AF ablation were included. Patients that had <30% low voltage zones (LVZs) in the left atrium underwent pulmonary vein isolation and GP ablation. Dominant frequency (DF), coronary sinus (CS) electrogram characteristics, and AF inducibility score were assessed pre- and post-GP ablation. Ganglionated plexi ablation response was determined. One hundred twenty patients were included, of which 84 (70.0%) patients had <30% LVZs and underwent GP ablation. An ablation response was seen in all patients [AF termination (66.7%) and CL slowing of ≥30 ms (33.3%)]. The average DF, CS cycle length variability (CLV), and CS activation pattern stability (APS) pre-GP ablation were predictive of AF termination. Ganglionated plexi ablation resulted in a significant change in the DF (6.3 ± 1.2 Hz pre-GP ablation vs. 5.1 ± 1.0 Hz; P < 0.001), CS CLV (40.2 ± 6.5 ms vs. 28.2 ± 6.8%; P < 0.001), and CS APS (25.2 ± 5.8% vs. 35.2 ± 6.5%; P < 0.001). Atrial fibrillation inducibility was harder post-GP ablation than pre-GP ablation (3.8 ± 1.2 AF inducibility score pre-ablation vs. 1.3 ± 1.8 AF inducibility score post-ablation; P < 0.001). Seventy-eight out of the 84 (92.9%) patients were free from AF/atrial tachycardia (AT) off anti-arrhythmic drugs at 12-months. CONCLUSION: Ganglionated plexi ablation results in a mechanistic impact in AF with an ablation response, changes in DF, CS electrogram characteristics, and AF inducibility score. Pulmonary vein isolation and GP ablation in patients with minimal LVZs results in a high freedom from AF/AT.
Source: EP Europace
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,909
OpenAlex ID: W4413571932