The Relationship between Acute Termination by Ganglionated Plexi Ablation and Cycle Length of Atrial Fibrillation

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The antifibrillatory effect of ganglionated plexi (GP) ablation is not well established. The aim of this study was to evaluate the factors associated with termination during GP ablation in patient with paroxysmal AF. Methods: Thirty-two consecutive paroxysmal AF patients (age 61±10 years, 25 male) who underwent the selective GP ablation guided by high frequency stimulation (HFS) were enrolled in this study. The five major left atrial GP were localized by delivering HFS (20 Hz, 20 V, 10 ms pulse width). Radiofrequency current is then applied to that site to eliminate the parasympathetic response. We ablated GP first, and antrum PV electrical isolation (APVI) adjunctively. We measured cycle length (CL) in each PV, left atrial appendage (LAA), coronary sinus (CS), RA, during AF before any ablation. We investigated the termination of AF in relation with GP ablation. Results: AF was induced and sustained in 29 patients. AF terminated during GP ablation in 14 patients (48%), during APVI in 6 patients (21%). Two of 3 patients without sustained AF had SVC foci. The LAA and CS AFCL (142±22 ms, 138±19 ms) in 9 patients without termination were shorter than that in 20 patients with termination (170±33 ms, 171±27 ms, p<0.05). Conclusions: Selective GP ablation alone showed antifibrillatory effects particularly in patients with the low degree atrium remodeling. Adjunctive APVI strengthened these effects.