Impact of Ganglionated Plexus Ablation on Early Recurrence After Thoracoscopic Atrial Fibrillation Ablation: A Post Hoc Analysis of the AFACT Study

ABSTRACT Background Early recurrences of atrial fibrillation (AF) after ablation are often considered transient. However, they may be caused by a combination of temporary and permanent proarrhythmogenic factors. Objective We evaluated whether adjunctive GP ablation was associated with the timing and clinical implications of early AF recurrence, and explored the hypothesis that autonomic mechanisms contribute to early recurrence. Methods Using data from the randomized AFACT study, we compared patients with advanced AF who underwent stand‐alone thoracoscopic ablation with or without GP ablation. Early recurrence was defined as AF or atrial tachycardia recurrence within 90 days postoperative. Cox models were used to assess time‐dependent effects and identify clinical predictors. Results A total of 235 patients were included in the current analysis. Seventy‐one patients had early recurrence: 36 in the GP ablation group and 35 in the non‐GP ablation group ( p = 0.730). Of these, 45 (63%) occurred within the first 30 days. Patients in the GP ablation group had their first recurrence later than those in the non‐GP group (24 [14–34] vs. 14 [11–24] days, p = 0.046). In the GP ablation group, markers of arrhythmogenic substrate (i.e., age, left atrial volume index, diabetes, CHA 2 DS 2 ‐VASc score, and persistent AF) were associated with early recurrence. Additionally, early recurrence was associated with late recurrence in the GP ablation group, but not in the non‐GP ablation group. Conclusion Adjunctive GP ablation was associated with later onset of first early recurrence, while the overall early recurrence rate was not reduced. In the GP ablation group, early recurrence was associated with subsequent late recurrence. These exploratory findings are compatible with a model in which early recurrence reflects both transient autonomic triggers and pre‐existing substrate, but this mechanism remains hypothesis‐generating. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01091389.