Effect of ganglionated plexi ablation by high-density mapping on long-term suppression of paroxysmal atrial fibrillation - The first clinical survey on ablation of the dorsal right plexusus.

Autor:	Morita N; Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan., Iida T; Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan., Nanao T; Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan., Ushijima A; Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan., Ueno A; Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan., Ikari Y; Division of Cardiology, Department of Medicine, Tokai University Hospital, Kanagawa, Japan., Kobayashi Y; Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	Heart rhythm O2 [Heart Rhythm O2] 2021 Jul 15; Vol. 2 (5), pp. 480-488. Date of Electronic Publication: 2021 Jul 15 (Print Publication: 2021).
DOI:	10.1016/j.hroo.2021.07.002
Abstrakt:	Background: Long-term outcomes of suppressing paroxysmal atrial fibrillation (PAF) with additive ganglionated plexus (GP) ablation (GPA) remains unknown. Objectives: The aim of the study is to assess potential role of additional GPA for PAF suppression. Methods: This study consisted of 225 patients; 68 (group A: 58 male, aged 60 ± 11 years) underwent pulmonary vein isolation (PVI) alone and 157 (group B: 137 male, aged 61 ± 11 years) GPA followed by PVI. GPA was performed based on the high-density mapping with high-frequency stimulation (HFS) delivered to left atrial (LA) major GP. The latter 85 group B patients (54%) underwent ablation to a posteromedial area within superior vena cava as a part of dorsal right atrial GP (SVC-Ao GP). Results: In group B, HFS was applied to 126 ± 32 sites, with a median of 47 GP sites (40.0%) being ablated. In patients undergoing an SVC-Ao GPA, HFS and the SVC-Ao GPA were applied at a median of 15 and 4 sites (29.4%), respectively. The PVI with a GPA provided higher PAF suppression than a PVI alone during more than 4 years of follow-up (56.7% vs 38.2%, odds ratio: 0.42, 95% confidence interval: 0.23-0.76, P < .05), but the SVC-Ao GPA did not provide further suppressive effects. Multivariate analyses revealed that tachycardia-bradycardia syndrome and non-PV foci were independent predictors of PAF recurrence after PVI with a GPA ( P < .01). Conclusion: GPA to LA major GP by high-density mapping provides long-term benefits for PAF suppression over 4 years of follow-up, but the effect of an empiric SVC-Ao GPA could not be appreciated, suggesting little effect on suppressing non-PV foci. (© 2021 Heart Rhythm Society. Published by Elsevier Inc.)
Databáze:	MEDLINE
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