LATE EFFECTIVENESS OF RADIOFREQUENCY PULMONARY VEIN ISOLATION, GANGLIONIC PLEXUS ABLATION, AND THEIR COMBINATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION

To assess late effectiveness of the following techniques of radiofrequency ablation (RFA) of atrial fibrillation (AF): pulmonary vein isolation (PVI), left atrium (LA) ganglionic plexus ablation (GPA), and their combination, according to the data of implantable loop recorders in patients with paroxysmal AF during a 2 year follow-up period, 327 patients were examined. The patients were randomized into three following groups: Group I (n=112) with PVI, Group II (n=108) with anatomic GPA, and Group III (n=107) with PVI in combination with GPA. The circular PVI was performed using the navigation system CARTO (Biosense Webster Inc.) by the commonly accepted technique, without linear ablations made in LA. During GPA, main accumulations of autonomic ganglionic plexuses concentrated in four LA areas were affected. At the end of procedure, loop recorders were implanted to all subjects. The follow-up period after the procedure was 24 months. Freedom from AF paroxysms (AF <0.5%) or any other arial arrhythmias according to the loop recorder data after a single ablation procedure was the primary endpoint. In Group I, 78.4±14.5 radiofrequency applications were performed. The sinus rhythm was restored in 16 patients (14.3%) during RFA; in 18 patients (16.1%), electric cardioversion was required. RFA of cavo-tricuspid isthmus was performed in 26 patients (23.2%). In Group II, 69.5±11.7 radiofrequency applications were performed. The sinus rhythm was restored in 14 patients (13%) during RFA; in 22 patients (20.4%), electric cardioversion was carried out. RFA of cavo-tricuspid isthmus was performed in 12 patients (18.5%). In Group III, the number of radiofrequency applications made up 102.7±12.4 (p=0.04 as compared with Group I and Group II). The sinus rhythm was restored during the procedure in 19 patients (17.8%); in 18 patients (16.8%), after the procedure, electric cardioversion was required. RFA of cavo-tricuspid isthmus was performed in 27 patients (25.2%) (p=0.2). By the end of follow-up period, 73 patients of Group I (65.2%), 69 patients of Group II (63.9%), and 84 patients of Group III (78.5%) were responders, i.e. had the AF percentage <0.5% according to the implantable loop recorder data. Thus, the combination of anatomic GPA and circular PVI is associated with an increased effectiveness of the procedure as compared with that of the isolated procedures of GPA and PVI, which ensures the sinus rhythm retention in 78.5% of patients with paroxysmal AF within the 24 month follow-up period according to the loop recorder data.

paroxysmal atrial fibrillation, pulmonary vein isolation, ganglionic plexus ablation, continuous subcutaneous ECG monitoring

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