Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Clinical Trials D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-029 - The Additional Effect Of Inferior Ganglionated Plexi Ablation On Pulmonary Vein Isolation In Patient With Non Paroxysmal Atrial Fibrillation (ID 1347)

 A. Matsumoto: Nothing relevant to disclose.


Background: PVI has used as the corner stone strategy of AF therapy. However, PVI alone cannot cure of all patients with AF. Although the adjunctive therapy was conducted to the patient with non-paroxysmal AF, that additional effect has reported to be little. On the other hand, GP ablation was well known, but the additional effect on PVI was not still elucidated.
Objective: The purpose of this study is to investigate the additional effect of the inferior GP ablation for non-paroxysmal AF.
Methods: Ninety-one patients with non-paroxysmal AF who were conducted catheter ablation from September 2017 to March 2019 were retrospectively enrolled. The patient with conducting PV isolation using a contact force or an ablation index of CARTO system were included in this study. Our strategy against non-paroxysmal AF is ablating the GP positive site in addition to PVI plus non-PV foci ablation. Our PVI line was designed to include the marshall tract GP, superior left GP and anterior right GP. For that reason,we searched for the inferior left GP and inferior right GP by 50 Hz high frequency stimulation and ablated the site where the GP response was positive and non-PV foci. However, if the durable lesion of PVI was not completed, we conducted internal cardioversion for easily detecting the gap and completed PVI. Although we tried to induce AF, if AF not induced, we performed PVI and non-PV foci alone. We divided the non-paroxysmal AF into three groups (PVI and non-PV foci ablation for non-paroxysmal AF [group 1], PVI and non PV foci ablation plus inferior GP ablation for persistent AF [group 2] and PVI and non-PV foci ablation plus inferior GP ablation for long standing persistent AF [group 3]) and evaluated the additional effect of inferior GP ablation.
Results: 50 patients were persistent AF and 41 patients were Long standing persistent AF. 41 patients were group 1, 37 patients were group 2, and 13 patients were group 3. Although there was not significant difference in three groups for survival rate (Figure), Group 1 was 97.6 %,group 2 was 75.7 %,and Group 3 was 92.3 %
Conclusion: The PVI and non-PV foci ablation in addition to inferior GP ablation was 97.6 % at high event free rate. The inferior GP ablation might be effective for persistent AF but might not be effective for long standing persistent AF.