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“To detect or to Ablate” - Determinants of Successful Left Atrial Ganglionated Plexi Detection During Surgical Ablation of Persistent Atrial Fibrillation
Grzegorz Suwalski, Leszek Gryszko, Kamil Kaczejko, Jakub Mroz, Andrzej Skrobowski.
Military Institute of Medicine, Warsaw, Poland.

OBJECTIVE: Left atrial ganglionated plexi (GP) ablation is adjuvant technique to increase success rate of surgical ablation of atrial fibrillation (AF). Effectiveness of that procedure is still to be proven. GP ablation requires its detection with rapid atrial pacing to provoke vagal reflex. We aimed to assess preoperative determinants of successful GP detection and factors correlating with number of GP detected.
METHODS: The study involved 22 consecutive patients with persistent and long-lasting persistent atrial fibrillation and coronary artery disease referred for surgical revascularization with concomitant left atrial ablation and left atrial appendage epicardial occlusion. GP detection was done with rapid stimulation (800 beats/min.) to induce the vagal reflex in the area of the PVs and left atrial fat pads.
RESULTS: Detection of GP was successful in 77 % (17 patients). In 23% of study population during epicardial mapping no signs of vagal reflex was observed. Significantly more GP were detected on the right side (29 GP; mean 1,7 +/- 0,9) than on the left side (16 GP; mean 0,9 +/- 1; p=0,03). There was no significant difference in preoperative characteristics and type of AF between patients in whom detection was successful and unsuccessful. GP were detected in 71% (12) of patients with persistent AF and in all patients (5 pts.) with long-lasting persistent AF (p=0,3). Number of detected GP correlated significantly only with preoperative rest heart rate. Negative correlation was still significant when study population was divided in to following groups: HR > 60 beats/min. (r=-0,6531; p=0,004); HR > 70 beats/min. (-0,5489; p=0,02) and HR > 80 beats/min. (r=-0,5401; p=0,02).
CONCLUSIONS: Number of detected GP is related only with preoperative heart rate. This observation may support rationale for direct ablation of potential ganglia location without its previous detection.

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