1003Ganglion Plexus Ablation in Patients with Advanced Atrial Fibrillation: 2-Year Outcomes of the AFACT study

Abstract

Introduction: The AFACT study showed no effect of additional ganglion plexus (GP) ablation in patients with advanced AF undergoing thoracoscopic AF surgery at one year follow-up. Importantly, GP ablation was associated with more major bleeding, sinus node dysfunction and pacemaker implantation. It is unknown whether additional GP ablation exerts effects in the mid-term. Purpose: To determine the efficacy and safety of GP ablation versus no GP ablation during two years of follow-up. Methods: All patients underwent thoracoscopic pulmonary vein isolation. Patients with persistent AF also received additional lines (Dallas lesion set). Patients were randomised 1:1 to additional epicardial ablation of the four major GPs and Marshall's ligament or no extra ablation (control). Patients were followed every three months up to 18 months and at 24 months. After an initial 3-month blanking period all antiarrhythmic drugs were discontinued. Results: In the AFACT study, 240 patients were randomised to either GP or no GP ablation, of whom 213 patients (age 5968 years, 73% men, 68% enlarged left atrium, 59% persistent AF) completed follow-up at 2 years. Freedom of any atrial arrhythmia, lasting more than 30 seconds, did not differ significantly in the GP (n=103) and control (n=110) group (respectively 55.8% versus 53.2%, p=0.6), irrespective of whether patients had paroxysmal (p=0.78) or persistent AF (p=0.46). After 2 years, the burden of AF was limited in most patients. However, 12.7% of patients had >3 recurrences per year 12.7% in the GP arm and 12.6% in the controls (figure). More than 3 recurrences per year occurred in 2.2% of paroxysmal AF patients and 20.3% of persistent AF patients. At 2 years, 83% of patients were not taking antiarrhythmic drugs and 92% of patients were in sinus rhythm. There were no late complications associated with GP ablation. Conclusion: Ganglion plexus ablation during thoracoscopic AF surgery for advanced AF has no effect on mid-term freedom of AF recurrence. These results emphasize that ablation of the GPs should not routinely be performed, as it causes more major procedural complications.