Ectopy-triggering ganglionated plexus ablation is feasible as a solo strategy for persistent and longstanding persistent atrial fibrillation treatment.

Background: The GANGLIA-AF trial showed that ectopy-triggering ganglionated plexus (ET-GP) ablation alone, without pulmonary vein isolation (PVI), can prevent paroxysmal AF with similar success rates to PVI alone. However, it is not known if ET-GP mapping and ablation is feasible in persistent AF.

Objectives: To perform mapping and ablation of left atrial ET-GP in patients with persistent AF and assess 1-year freedom from ≥30s AF/AT.

Methods: Patients with persistent AF, undergoing ablation, were pre-treated with amiodarone. 3D geometry (CARTO™/Precision™) was collected in sinus rhythm following cardioversion. ET-GPs were mapped by delivering endocardial high-frequency stimulation (HFS) within the atrial refractory period and ablated until they became nonfunctional. If triggered AF became incessant, atrioventricular dissociating GPs (AVD-GPs) were ablated. No PVI was performed. Patients were followed up for 1 year to assess the recurrence of AF/AT.

Results: Forty-nine patients completed GP ablation (64±9 years, 76% male, LAd 46±8 mm, AF duration 3.4±2.5 years, continuous AF ≥ 12 months: 41%). HFS was performed at a mean of 110 ± 20 sites, identifying 15±9 GPs/patient (ET-GP only 12/49 [25%], combination 31/49 [63%], AVD-GP only 6/49 [12%]). ET-GP only ablation (12±8 ET-GP) had higher freedom from persistent AF recurrence (11/12 [92%]) than combination ET/AVD-GP ablation (17±9 GP, 13/31 [42%]) or AVD-GP only ablation (4±0 AVD-GP, 1/6 [17%]), (p=0.005). One-year freedom from ≥30s AF/AT was 16/49 (33%) and freedom from persistent AF was 25/49 (51%) for the whole cohort.

Conclusion: ET-GP mapping and ablation, as a solo ablation strategy, is feasible in persistent AF and can prevent AF recurrence at 1 year.