Imperial College London
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DrZacharyWhinnett

Faculty of Medicine, National Heart & Lung Institute

Reader in Cardiac Electrophysiology
 
 
 
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z.whinnett

 
 
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Location

 

South- NHLI Cardiovascular ScienceBlock B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kim:2022:10.1016/j.hrthm.2021.12.010,
author = {Kim, M-Y and Coyle, C and Tomlinson, DR and Sikkel, MB and Sohaib, A and Luther, V and Leong, KM and Malcolme-Lawes, L and Low, B and Sandler, B and Lim, E and Todd, M and Fudge, M and Wright, I and Koa-Wing, M and Ng, FS and Qureshi, NA and Whinnett, ZI and Peters, NS and Newcomb, D and Wood, C and Dhillon, G and Hunter, RJ and Lim, PB and Linton, NW and Kanagaratnam, P},
doi = {10.1016/j.hrthm.2021.12.010},
journal = {Heart Rhythm},
pages = {516--524},
title = {Ectopy-triggering ganglionated plexus ablation to prevent atrial fibrillation: GANGLIA-AF study.},
url = {http://dx.doi.org/10.1016/j.hrthm.2021.12.010},
volume = {19},
year = {2022}
}
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TY  - JOUR
AB  - BACKGROUND: The ganglionated plexuses (GP) of the intrinsic cardiac autonomic system may play a role in atrial fibrillation (AF). OBJECTIVES: We hypothesized that ablating the ectopy-triggering GPs (ET-GP) prevents AF. METHODS: GANGLIA-AF (NCT02487654) was a prospective, randomized, controlled, 3-centre trial. ET-GP were mapped using high frequency stimulation (HFS), delivered within the atrial refractory period and ablated until non-functional. If triggered AF became incessant, atrioventricular dissociating GPs (AVD-GP) were ablated. We compared GP ablation (GPA) without pulmonary vein isolation (PVI) against PVI, in patients with paroxysmal AF. Follow-up was for 12 months including 3-monthly 48hr Holter monitors. The primary endpoint was documented ≥30s atrial arrhythmia after a 3-month blanking period. RESULTS: 102 randomized patients were analysed on a per-protocol basis after GPA (n=52) or PVI (n=50). GPA patients had 89±26 HFS sites tested, identifying median 18.5 (IQR 16; 21%) GPs. RF ablation time in GPA was 22.9±9.8mins and 38±14.4mins in PVI (p<0.0001). The freedom from ≥30s atrial arrhythmia at 12-month follow-up with GPA was 50% (26/52) vs 64% (32/50) with PVI (log rank p=0.09). ET-GP ablation without AVD-GP ablation achieved 58% (22/38) freedom from the primary endpoint. There was a significantly higher reduction in AAD usage post-ablation after GPA vs PVI (55.5% vs 36%; p=0.05). Patients were referred for redo ablations in 31% (16/52) after GPA and 24% (12/50) after PVI (p=0.53). CONCLUSIONS: GPA did not prevent atrial arrhythmias more than PVI. However, less RF ablation was delivered to achieve a higher reduction in AAD usage with GPA than PVI.
AU  - Kim,M-Y
AU  - Coyle,C
AU  - Tomlinson,DR
AU  - Sikkel,MB
AU  - Sohaib,A
AU  - Luther,V
AU  - Leong,KM
AU  - Malcolme-Lawes,L
AU  - Low,B
AU  - Sandler,B
AU  - Lim,E
AU  - Todd,M
AU  - Fudge,M
AU  - Wright,I
AU  - Koa-Wing,M
AU  - Ng,FS
AU  - Qureshi,NA
AU  - Whinnett,ZI
AU  - Peters,NS
AU  - Newcomb,D
AU  - Wood,C
AU  - Dhillon,G
AU  - Hunter,RJ
AU  - Lim,PB
AU  - Linton,NW
AU  - Kanagaratnam,P
DO  - 10.1016/j.hrthm.2021.12.010
EP  - 524
PY  - 2022///
SN  - 1547-5271
SP  - 516
TI  - Ectopy-triggering ganglionated plexus ablation to prevent atrial fibrillation: GANGLIA-AF study.
T2  - Heart Rhythm
UR  - http://dx.doi.org/10.1016/j.hrthm.2021.12.010
UR  - https://www.ncbi.nlm.nih.gov/pubmed/34915187
UR  - https://www.sciencedirect.com/science/article/pii/S1547527121024358?via%3Dihub
UR  - http://hdl.handle.net/10044/1/93506
VL  - 19
ER  -
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