{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:23:49Z","timestamp":1780122229392,"version":"3.54.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/13\/73\/30352"],"award-info":[{"award-number":["FS\/13\/73\/30352"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ganglionated plexuses (GPs) are implicated in atrial fibrillation (AF). Endocardial high\u2010frequency stimulation (HFS) delivered within the local atrial refractory period can trigger ectopy and AF from specific GP sites (ET\u2010GP). The aim of this study was to understand the role of ET\u2010GP ablation in the treatment of AF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with paroxysmal AF indicated for ablation were recruited. HFS mapping was performed globally around the left atrium to identify ET\u2010GP. ET\u2010GP was defined as atrial ectopy or atrial arrhythmia triggered by HFS. All ET\u2010GP were ablated, and PVs were left electrically connected. Outcomes were compared with a control group receiving pulmonary vein isolation (PVI). Patients were followed\u2010up for 12 months with multiple 48\u2010h Holter ECGs. Primary endpoint was \u226530\u2009s AF\/atrial tachycardia in ECGs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 67 patients were recruited and randomized to ET\u2010GP ablation (<jats:italic>n<\/jats:italic>\u2009=\u200939) or PVI (<jats:italic>n<\/jats:italic>\u2009=\u200928). In the ET\u2010GP ablation group, 103\u2009\u00b1\u200928 HFS sites were tested per patient, identifying 21\u2009\u00b1\u200910 (20%) GPs. ET\u2010GP ablation used 23.3\u2009\u00b1\u20094.1\u2009kWs total radiofrequency (RF) energy per patient, compared with 55.7\u2009\u00b1\u200922.7\u2009kWs in PVI (<jats:italic>p<\/jats:italic>\u2009=\u2009&lt;.0001). Duration of procedure was 3.7\u2009\u00b1\u20091.0 and 3.3\u2009\u00b1\u20090.7\u2009h in ET\u2010GP ablation group and PVI, respectively (<jats:italic>p<\/jats:italic>\u2009=\u2009.07). Follow\u2010up at 12 months showed that 61% and 49% were free from \u226530\u2009s of AF\/AT with PVI and ET\u2010GP ablation respectively (log\u2010rank <jats:italic>p<\/jats:italic>\u2009=\u2009.27).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>It is feasible to perform detailed global functional mapping with HFS and ablate ET\u2010GP to prevent AF. This provides direct evidence that ET\u2010GPs are part of the AF mechanism. The lower RF requirement implies that ET\u2010GP targets the AF pathway more specifically.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.14870","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T01:13:28Z","timestamp":1610673208000},"page":"235-244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Targeting the ectopy\u2010triggering ganglionated plexuses without pulmonary vein isolation prevents atrial fibrillation"],"prefix":"10.1111","volume":"32","author":[{"given":"Belinda","family":"Sandler","sequence":"first","affiliation":[{"name":"Myocardial Function Section, National Heart and Lung Institute Imperial College London  London UK"},{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6441-1798","authenticated-orcid":false,"given":"Min\u2010Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Myocardial Function Section, National Heart and Lung Institute Imperial College London  London UK"},{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus B.","family":"Sikkel","sequence":"additional","affiliation":[{"name":"Myocardial Function Section, National Heart and Lung Institute Imperial College London  London UK"},{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"},{"name":"Department of Cardiology, Hammersmith Hospital Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Malcolme\u2010Lawes","sequence":"additional","affiliation":[{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"},{"name":"Department of Cardiology, Hammersmith Hospital Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Koa\u2010Wing","sequence":"additional","affiliation":[{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"},{"name":"Department of Cardiology, Hammersmith Hospital Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary I.","family":"Whinnett","sequence":"additional","affiliation":[{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"},{"name":"Department of Cardiology, Hammersmith Hospital Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Coyle","sequence":"additional","affiliation":[{"name":"Myocardial Function Section, National Heart and Lung Institute Imperial College London  London UK"},{"name":"Imperial Centre for Cardiac Engineering Imperial College London  London UK"},{"name":"Department of Cardiology, Hammersmith Hospital Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5712-849X","authenticated-orcid":false,"given":"Nick W. 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