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Multicenter randomized study evaluating the outcome of ganglionated plexi ablation in maze procedure



The benefit of adding ganglionated plexi ablation to the maze procedure remains controversial. This study aims to compare the outcomes of the maze procedure with and without ganglionated plexi ablation.


This multicenter randomized study included 74 patients with atrial fibrillation associated with structural heart disease. Patients were randomly allocated to the ganglionated plexi ablation group (maze with ganglionated plexi ablation) or the maze group (maze without ganglionated plexi ablation). The lesion sets in the maze procedure were unified in all patients. High-frequency stimulation was applied to clearly identify and perform ganglionated plexi ablation. Patients were followed up for at least 6 months. The primary endpoint was a recurrence of atrial fibrillation.


The intention-to-treat analysis included 69 patients (34 in the ganglionated plexi ablation group and 35 in the maze group). No surgical mortality was observed in either group. After a mean follow-up period of 16.3 ± 7.9 months, 86.8% of patients in the ganglionated plexi ablation group and 91.4% of those in the maze group did not experience atrial fibrillation recurrence. Kaplan–Meier atrial fibrillation–free curves showed no significant difference between the two groups (P = .685). Cox proportional hazards regression analysis indicated that left atrial dimension was the only risk factor for atrial fibrillation recurrence (hazard ratio: 1.106, 95% confidence interval 1.017–1.024, P = .019).


The addition of ganglionated plexi ablation to the maze procedure does not improve early outcome when treating atrial fibrillation associated with structural heart disease.

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This study was funded by the Japanese Society of Arrhythmia Surgery.

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Correspondence to Shun-Ichiro Sakamoto.

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Goro Matsumiya received a research grant from Century Medical, Edwards Lifescience, and Medtronic. All other author has no conflict of interest.

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Sakamoto, SI., Ishii, Y., Otsuka, T. et al. Multicenter randomized study evaluating the outcome of ganglionated plexi ablation in maze procedure. Gen Thorac Cardiovasc Surg (2022).

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  • Ganglionated plexi ablation
  • Maze procedure
  • Atrial fibrillation