The impact of ganglionic plexii ablation in addition to pulmonary vein isolation on EKG intervals in patients undergoing atrial fibrillation ablation

Abstract Background Recently ganglionic plexii (GP) ablation has shown a potential benefit in reducing atrial fibrillation (AF) recurrence. Preclinical models suggest a possible arrhythmogenic effect of cardioneural dyslexia. However, this has not been seen in patients undergoing GP ablation EKG intervals post-ablation could serve as a surrogate for arrhythmogenic impact. Methods As a quality improvement initiative, we studied EKG intervals pre and post-ablation in AF patients undergoing pulmonary vein isolation with and without GP ablation. We compared EKG interval changes in patients who underwent GP ablation (GPP) in addition to pulmonary vein isolation (PVI), with those who underwent PVI alone by radiofrequency ablation from 12/22 until 11/23. Results Of 56 patients, there were 28 (50%) GPP patients. Baseline demographics were similar. There was a higher proportion of paroxysmal AFib (PxAF ) patients in the GPP group compared to PVI to group. (57% Vs 39%, P<0.01). The QTc values were similar in GPP and PVI respectively (452 Vs 439, p=ns). The QTc post-procedure were 465 and 463 ms for PVI and GPP respectively (p=0.768). The delta QTc of the GPP and PVI groups were 11.0 ms and 25.4 respectively (p=ns). Antiarrhythmic drug therapy did not affect delta QTc in GPP and PVI (p=ns). Delta QTc prolongation was similar in PxAF (45 vs 28, p =ns) and persistent (PsAF) (0.7 Vs 7.5, p= ns) patients undergoing GPP vs. PVI. PxAF showed a higher increase in delta QTc compared to the PsAF (41 vs. 5, p=<.0001). On multivariate analysis, PxAF (p<0.001) was an independent predictor of QT prolongation regardless of AAD (p=0.4) or ablation type (p=0.8). There is no difference in delta PR interval in the groups regardless of PxAF or PsAF. (p=0.3). Conclusion Paroxysmal AF patients had a higher prolongation in delta QTc compared to persistent patients in the cohort. This was not influenced by GPP ablation or AAD status.