The Impact of Ganglionic Plexii Ablation in Addition to Pulmonary Vein Isolation on Procedural Time and AF Recurrence Outcome
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Heart Rhythm
Abstract
Background: Ganglionic plexii (GP) ablation has shown to lower atrial fibrillation (AF) recurrence rates adding to pulmonary vein isolation (PVI). Objective: The impact of ablating identified GP+ PVI (GPi) vs. targeted active GP sites + PVI (GPa) vs. PVI on workflow and outcomes is not studied. Methods: As a Quality Improvement initiative, we studied AF patients who underwent ablation from 12/22 until 11/23. We divided them into 3 groups: Group 1 (GPi) underwent ablation of the identified GP (localized by the presence of .4 deflections outside the PVI); In Group 2 (GPa), after identification of GP, 50Hz stimulation at max output for 10 seconds was done. A positive response was defined for a 50% increase in the R-R interval or asystole or induction of atrial fibrillation. Targeted ablation of these active GP sites was done. Group 3 (PVI) underwent PVI alone. Results: Of 56 patients, there were 12, 16 and 28 patients in GPi, GPa and PVI groups. Patient demographics were similar + among groups. Patients with paroxysmal AF underwent more GPa and GPi compared to PVI procedures. Procedure times were similar: 164, 146.5 and 139.18 minutes in GPi, GPa and PVI respectively (p50.278). Mapping time (mins) was 9.9, 8.3, and 11.4 in GPi, GPa, and PVI respectively (p50.067). Total GP sites in GPi and GPa were 5.3 sites and 4.4 sites respectively (p50.42), & 25 of 71 (35%) of GP sites were active in the GPa group. Twelve (48%) GP sites had GP response abolished post ablation. Recurrence in GPi, GPa and PVI alone was 0, 0 and 7 patients respectively after 3 months follow-up (p50.0247). However, this was not significant on multivariate analysis. Conclusion: GPi and GPa did not significantly increase the mapping time or workflow time. At initial follow-up, GPa and GPi groups showed a signal for lower rate of recurrence compared to PVI but long-term follow-up is needed.
Volume
21
Issue
5S
First Page
S546
Recommended Citation
Meenakshisundaram C, Shoukri N, Ahmed SH, Brunk D, Gautam S, Haines DE, et al. [Mehta N]. The impact of ganglionic plexii ablation in addition to pulmonary vein isolation on procedural time and AF recurrence outcome. Heart Rhythm. 2024 May;21(5S):S546. doi:10.1016/j.hrthm.2024.03.1388
DOI
10.1016/j.hrthm.2024.03.1388
Comments
Heart Rhythm Society Annual Meeting, May 16-19, 2024, Boston, MA