Right anterior ganglionated plexus ablation for the treatment of vagally-mediated atrial fibrillation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation of atrial fibrillation (AF), however, exact mechanisms of PVI efficacy remain debatable. PVI is an invasive left-atrial procedure which may be associated with complications. It has been postulated that in patients with increased vagal tone AF can be treated by attenuation of parasympathetic drive to the heart using cardioneuroablation (CNA) by means of radiofrequency (RF) ablation of the ganglionated plexi, however, data in literature are lacking. Objectives To examine the mid-term efficacy of RF-CNA targeting the right anterior ganglionated plexus (RAGP) in the management of AF using right-atrial (RA) approach only. Methods We included consecutive 12 male patients (age 55±11) with vagally-mediated AF (decelaration capacity (DC) >7 ms, mean 11,2±3,7ms) who underwent RF-CNA of RAGP. RAGP was targeted anatomically at the septal area below superior vena cava (SVC) from RA only. The aim was to achieve ≥30% heart rate acceleration (HRA). The follow up consisted of regular visits combined with ECG conducted every 3 months and 24h or 7-day Holter ECG. Results The RF time was 126±61 sec, power - 34±7W and procedure time - 44±18 min. The ≥30% HRA was achieved in 7 (58%) patients (pre-RF vs post-RF: 58±7 bpm vs 80±9 bpm, p=0,0000013). There were no complications during procedures. The follow up lasted 11±6 months. All patients reported significant symptom improvement post-CNA. AF-free survival was significantly higher in patients with ≥30% HRA during RF-CNA (≥30% HRA vs <30% HRA, 60% vs 14%, log rank p=0,0203) Conclusions: Right atrial RF-CNA of RAGP can be effective in patients with vagally-mediated AF. Larger prospective studies are needed to confirm these preliminary findings.