Role of Ganglionic Plexus Ablation in Treatment of Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Background: The role of targeting the ganglion plexi (GP) in atrial fibrillation (AF) ablation remains unclear. The aim of this meta-analysis was to assess the efficacy of GP ablation in paroxysmal and persistent AF. Methods: We performed electronic searches of 4 databases for eligible case control and randomised control studies comparing GP ablation as a stand-alone procedure or GP ablation as an adjunct to other non-GP ablation strategies (GP ablation group) versus non-GP ablation strategies (Control group; e.g. PVI, MAZE, linear ablation). Studies of percutaneous catheter and/or surgical ablation were included. Results: We identified a total of ten trials comprising 1615 patients (798 in the GP group and 817 in the control group). Overall, GP ablation did not improve freedom from AF at 12 months (Figure 1; p = 0.12); this effect was consistent when examining studies of either percutaneous catheter ablation (p = 0.26) or surgical ablation (p = 0.29). Subgroup analysis showed no difference between GP vs. control groups in paroxysmal AF (p = 0.56). However, freedom from AF was worse with GP vs. control groups in persistent AF (Odds ratio 1.5; 95% CI 1.07-2.12; p = 0.02). Conclusion: GP ablation as a stand-alone or adjunctive treatment strategy does not appear to provide benefit compared to non-GP ablation strategies. Outcomes may be worse if GP ablation used either as a stand-alone strategy or as an adjunctive strategy in ablation of persistent AF.