Ganglion Plexus Ablation For Advanced Atrial Fibrillation: 2-years Results Of The Afact Study
Jolien Neefs1, Wouter R. Berger1, Sebastien P.J Krul1, Elise M. Praag1, Nicoline W.E van den Berg1, Femke Piersma1, Jonas S.S.G de Jong2, WimJan P. van Boven1, Antoine H.G Driessen1, Joris R. de Groot1.
1Academic Medical Center, Amsterdam, Netherlands, 2Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
Objective: The randomized AFACT study showed no effect of additional ganglion plexus (GP) ablation in patients with advanced AF undergoing thoracoscopic AF surgery at one year. However, GP ablation was associated with more major bleeding, sinus node dysfunction and pacemaker implantation. We determined the efficacy and safety of additional GP ablation to thoracoscopic AF surgery during 2 years follow-up in the AFACT trial. Methods: The AFACT study randomized 240 patients with advanced AF undergoing thoracoscopic pulmonary vein isolation 1:1 to no GP ablation or epicardial ablation of the four major GPs and Marshall’s ligament. In persistent AF patients a roof and trigone line were also made. Follow-up visits were every three months until 18 months and one at 2 years. After an initial 3-month blanking period, all antiarrhythmic drugs (AAD) were discontinued. Results: At two years information was available of 231 patients (age 59±8 years, 27% women, 65% enlarged left atrium, 60% persistent AF). Freedom of AF recurrence did not differ statically between the GP and no GP group (n=60, 54% vs. n=64, 54%; p=0.97), regardless of paroxysmal (p=0.66) or persistent AF (p=0.95). Twenty four percent of patients in both groups had >3 recurrences during follow up (fig). At 2 years 78% were off AADs. GP ablation was not associated with late complications.Conclusion: GP ablation during thoracoscopic AF surgery does not affect mid-term freedom of AF recurrence. As it causes more major procedural complications, ablation of the GPs should not routinely be performed.
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