Active ganglionated plexi is a predictor of atrial fibrillation recurrence after minimally invasive surgical ablation.

BACKGROUND AND AIM

Ganglionated plexi (GP) ablation has been become an important strategy for treating atrial fibrillation (AF). We hypothesize that active GP is a predictor of AF recurrence after minimally invasive surgical AF ablation.

METHODS

Eighty-nine patients with symptomatic lone AF undergoing minimally invasive surgical pulmonary vein isolation combined with GP testing and ablations were followed for a median of 50 months. Success was defined as freedom from any atrial tachyarrhythmia lasting >30 seconds duration.

RESULTS

The single-procedure success rate is 56.3% for paroxysmal AF, 27.3% for persistent AF, and 25% for long-term persistent AF. A mean of 4.1 active GPs were identified in each patient. There were more active GP on the right side than on the left side (2.8 ± 2.2 vs. 1.4 ± 1.2, p<0.001). The number of active GP independently predicted recurrence of AF at 12 months (hazard ratios [95% CI]: 0.67 [0.48, 0.95]; p=0.022), 24 months (0.71 [0.53, 0.95]; p=0.019), and 60 months (0.69 [0.54, 0.89]; p=0.004). Patients with active GP above 5 were associated with higher long-term success rates in comparison to patients with less active GP (p=0.014). Duration of AF >24 months, early recurrence of AF, and left atrial diameter also predicted long-term recurrences of AF.

CONCLUSIONS

The number of active GP is a predictor of AF recurrence after minimally invasive surgical AF ablation. Patients with more active GP were associated with markedly higher single-procedure success rates.