Ablation of ganglionic plexi during combined surgery for atrial fibrillation.

Abstract

Recent investigations into the treatment of atrial fibrillation have suggested improved outcomes after concomitant pulmonary vein isolation (PVI) and ganglionic plexi (GP) ablation. We investigated the impact of left atrial ablation with substrate modification (left atrial maze) or epicardial PVI, combined with GP mapping and ablation, in patients with paroxysmal or longstanding persistent atrial fibrillation undergoing additional off-pump or on-pump cardiac surgery. Twelve patients aged 74.9 +/- 3.8 years, with atrial fibrillation for 4.5 +/- 1.5 years, underwent left atrial maze or epicardial PVI, along with GP mapping and ablation during coronary bypass grafting with or without valve surgery. The GP mapping used high-frequency bipolar stimulation. The GP ablation and PVI were achieved using bipolar radiofrequency ablation. Conduction block was confirmed by pacing. At 1-year follow-up, 83% of patients were in sinus rhythm. Echocardiography confirmed satisfactory bi-atrial contraction. Exercise-induced heart rate variability was appropriate. There were no early deaths. Epicardial PVI, left atrial maze, GP mapping, and ablation for the treatment of atrial fibrillation can be effectively and safely performed during surgery for other cardiac pathologies.