Sequential hybrid procedure for persistent atrial fibrillation.

Abstract

BACKGROUND:

Catheter ablation of persistent atrial fibrillation yields an unsatisfactorily high number of failures. The hybrid approach has recently emerged as a technique that overcomes the limitations of both surgical and catheter procedures alone.

METHODS AND RESULTS:

We investigated the sequential (staged) hybrid method, which consists of a surgical thoracoscopic radiofrequency ablation procedure followed by radiofrequency catheter ablation 6 to 8 weeks later using the CARTO 3 mapping system. Fifty consecutive patients (mean age 62±7 years, 32 males) with long-standing persistent atrial fibrillation (41±34 months) and a dilated left atrium (>45 mm) were included and prospectively followed in an unblinded registry. During the electrophysiological part of the study, all 4 pulmonary veins were found to be isolated in 36 (72%) patients and a complete box-lesion was confirmed in 14 (28%) patients. All gaps were successfully re-ablated. Twelve months after the completed hybrid ablation, 47 patients (94%) were in normal sinus rhythm (4 patients with paroxysmal atrial fibrillation required propafenone and 1 patient underwent a redo catheter procedure). The majority of arrhythmias recurred during the first 3 months. Beyond 12 months, there were no arrhythmia recurrences detected. The surgical part of the procedure was complicated by 7 (13.7%) major complications, while no serious adverse events were recorded during the radiofrequency catheter part of the procedure.

CONCLUSIONS:

The staged hybrid epicardial-endocardial treatment of long-standing persistent atrial fibrillation seems to be extremely effective in maintenance of normal sinus rhythm compared to radiofrequency catheter or surgical ablation alone. Epicardial ablation alone cannot guarantee durable transmural lesions.

CLINICAL TRIAL REGISTRATION:

URL: www.ablace.cz Unique identifier: cz-060520121617.

• Authors: Alan Bulava, Ales Mokracek, Jiri Hanis, Vojtech Kurfirst, Martin Eisenberger, Ladislav Pesl
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 4 Issue 3 Pg. e001754 (Mar 25 2015) ISSN: 2047-9980 [Electronic] England
• PMID: 25809548 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Chemical References

• Anti-Arrhythmia Agents

Topics

• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (diagnosis, physiopathology, surgery)
• Catheter Ablation (adverse effects, methods)
• Disease-Free Survival
• Electrophysiologic Techniques, Cardiac
• Endocardium (physiopathology, surgery)
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Pericardium (physiopathology, surgery)
• Prospective Studies
• Pulmonary Veins (physiopathology, surgery)
• Recurrence
• Registries
• Reoperation
• Time Factors
• Treatment Outcome