{"doi":"10.1016/j.jacc.2013.06.053","title":"Autonomic Denervation Added to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation","abstract":"<h4>Objectives</h4>The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF).<h4>Background</h4>Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI.<h4>Methods</h4>A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period.<h4>Results</h4>Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered.<h4>Conclusions</h4>Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.","journal":"Journal of the American College of Cardiology","year":2013,"id":2378,"datarank":0.9046027890391897,"base_score":6.030685260261263,"endowment":6.030685260261263,"self_citation_contribution":0.9046027890391897,"citation_network_contribution":0.0,"self_endowment_contribution":0.9046027890391897,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":415,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.0438,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2013-12-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":29228,"name":"Evgeny Pokushalov","orcid":"0000-0002-2560-5167","position":1,"is_corresponding":false},{"id":29229,"name":"Alexander Romanov","orcid":"0000-0002-6958-6690","position":2,"is_corresponding":false},{"id":29230,"name":"Eleftherios Giazitzoglou","orcid":null,"position":3,"is_corresponding":false},{"id":6426,"name":"George C.M. Siontis","orcid":"0000-0003-2128-9205","position":4,"is_corresponding":false},{"id":29231,"name":"Sunny S. Po","orcid":"0000-0002-5283-6737","position":5,"is_corresponding":false},{"id":29232,"name":"A. John Camm","orcid":"0000-0002-2536-2871","position":6,"is_corresponding":false},{"id":148,"name":"John P. A. Ioannidis","orcid":"0000-0003-3118-6859","position":8,"is_corresponding":false},{"id":27676,"name":"Demosthenes G. Katritsis","orcid":"0000-0002-0696-8376","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}