Rapid pulmonary vein isolation combined with autonomic ganglia modification: A randomized study

BACKGROUND Evidence indicates that the combination of left atrial ganglionated plexi (GP) ablation and pulmonary vein (PV) isolation is beneficial for treatment of paroxysmal atrial fibrillation (AF). OBJECTIVE The purpose of this study was to compare GP and PV ablation with PV isolation alone for treatment of paroxysmal AF. METHODS Sixty-seven patients with paroxysmal AF were randomized to either PV isolation using a circular catheter suitable for both mapping and ablation (PV group) or anatomic GP modification followed by PV isolation (GP + PV group). Patients were seen at monthly visits, and 48-hour ambulatory ECG recordings were obtained every 3 months for a predefined follow-up period of 12 months. Primary endpoint was freedom from AF or other sustained atrial arrhythmia recurrence 3 to 12 months postablation after one or two procedures, without antiarrhythmic medications. RESULTS Recurrence of arrhythmia was documented in 18 (54.5%) patients in the PV group 4.7 +/- 1.0 months after ablation, and repeat PV isolation was performed in 7 (21.2%) of these patients 5.1 +/- 1.1 months after the first procedure. Recurrence of arrhythmia was documented in 9 (26.5%) patients in the GP + PV group 5.0 +/- 1.3 months after ablation, and repeat ablation was performed in 6 (17.6%) of these patients 4.3 +/- 0.5 months after the first procedure. At the end of follow-up, 20 (60.6%) patients in the PV group and 29 (85.3%) patients in the GP + PV group remained arrhythmia-free (log rank test, P = .019). CONCLUSION Addition of anatomic GP modification to PV isolation confers significantly better outcomes than PV isolation alone during a follow-up period of 12 months.