The Efficacy and Clinical Outcome of EEPVI and Additional Inferior GP Ablation in Patients with Persistent Atrial Fibrillation

Abstract

Purpose: This study aimed to evaluate the effect of extensive encirculing pulmonary vein isolation (EEPVI) and additional inferior ganglionated plexi (GP) ablation in patients with persistent atrial fibrillation (PeAF). Methods: Thirty four patients with PeAF (Age 62.9±11.4, 27 males) undergoing EEPVI and inferior GP ablation were included. Mapping of complex fractionated atrial electrograms (CFAEs; a mean cycle length of <120 ms during a 5-second) was performed before and after ablation using EnSite NavX. We followed the patients after ablation procedure and assessed AF recurrence. Results: The CFAE area decreased from 81.3±29.1 to 35.8±13.2 cm² before and after ablation (56% reduction, p<0.0001). In 29/34 (85%) patients inferior GP sites were detected. AF was induced in 9 patients and additional ablation was performed (left atrial posterior wall isolation in 4, superior vena cava isolation in 4 and focal ablation of atrial septum in 1 patients). During follow-up (10.4±5.2 months), AF free rate was 62% (50% off antiarrhythmic drugs and 12% with AF controlled with antiarrhythmic drugs). Only 2 patients remains PeAF. Conclusions: These results indicate that EEPVI with additional inferior GP ablation leads to significant decrease in the CFAE area and high maintenance of sinus rhythm without CFAE ablation in patients with PeAF.