Six controlled trials (342 patients, range 32 to 75) were included in the review. One trial reported adequate sequence generation. None of the trials reported allocation concealment or blinded assessments of outcomes. Attrition was less than 15% in all the studies. Intention-to-treat analyses were performed in all the trials. Follow-up was complete in five trials. Monitoring of atrial fibrillation was adequate in all the trials.
Freedom from atrial fibrillation or other sustained arrhythmia at 12 months was significantly improved in patients who received ganglionated plexi ablation in addition to pulmonary vein isolation or the maze procedure compared to patients who received pulmonary vein isolation or Maze without ganglionated plexi ablation (OR 5.66, 95% 2.97 to 10.82; four trials; Ι²=0%). Ablation of the ganglionated plexi was associated with statistically significant aggravation of atrial fibrillation or sustained atrial arrhythmia recurrence compared to pulmonary vein isolation alone (OR 0.32, 95% CI 0.14 to 0.73; two trials; Ι²=0%).
Early recurrence of atrial arrhythmia was significantly higher in patients treated with ganglionated plexi ablation alone compared with pulmonary vein isolation alone (OR 2.75, 95% CI 1.20 to 6.27; two trials; Ι²=0%). There were no differences in early recurrence between patients treated with ganglionated plexi ablation plus pulmonary vein isolation or Maze procedure (four trials).
Two studies (145 patients) assessed complications. One study reported no deaths during hospitalisation and no ablation device-related complications. One study reported one case of cardiac tamponade. One trial had non-significant narrowing of both superior pulmonary veins in patients who received ganglionated plexi ablation. Among patients treated with pulmonary vein isolation, one had significant left superior pulmonary vein stenosis diagnosed four months post-ablation and one had significant upper respiratory tract bleeding 25 months post procedure.