The effectiveness of catheter ablation of GP in patients with AF remains controversial. One of the major challenges has been the lack of a sensitive and specific means to localize the GP in patients.117,118,119,120 Whereas several small studies have reported improved outcomes using an anatomically based approach to localize autonomic ganglia, these findings have not been replicated by other investigators.121,122 A recent prospective randomized surgical AF ablation study reported no improvement of outcomes by ablation of autonomic ganglia.123