Ganglionated plexi ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/longstanding persistent atrial fibrillation: a randomized comparison

Introduction: The optimal ablation technique for persistent and longstanding persistent Atrial Fibrillation (AF) is unclear. Both Linear Lesions (LL) and Ganglionated Plexi (GP) ablation have been used, in addition to Pulmonary Vein Isolation (PVI), but no direct comparison of the two methods exists. Methods: Two hundred sixty four consecutive patients with persistent/longstanding persistent AF were randomly assigned to 2 different ablation schemes: PVI+LL (n=132) and PVI+GP ablation (n=132). Consistent Sinus Rhythm (SR) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device (IMD). Results: All procedural endpoints were acutely achieved. At 12 months following a single procedure, 47% of patients treated with PVI+LL were in SR compared to 54% of patients treated with PVI+GP (p=0.29). At 3 years, 34% of patients with PVI+LL and 49% of patients with PVI+GP maintained SR (p=0.035). Atrial flutter was more frequent in PVI+LL than in PVI+GP ablation group (18% versus 6%, P=0.002). After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group, the long-term overall success rate was 52% and 68%, respectively (p=0.006). Conclusions: PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL at 3 years of follow-up.