First-line treatment of persistent and long-standing persistent atrial fibrillation with single-stage hybrid ablation: a 2-year follow-up study

Abstract

Aims This study evaluates the efficacy and safety of first-line single-stage hybrid ablation of (long-standing) persistent atrial fibrillation (AF), over a follow-up period of 2 years, and provides additional information on arrhythmia recurrences and electrophysiological findings at repeat ablation. Methods and results This is a prospective cohort study that included 49 patients (65% persistent AF; 35% long-standing persistent AF) who underwent hybrid ablation as first-line ablation treatment (no previous endocardial ablation). Patients were relatively young (57.0 ± 8.5 years) and predominantly male (89.8%). Median CHA2DS2-VASc score was 1.0 (0.5; 2.0) and mean left atrium volume index was 43.7 ± 10.9 mL/m2. Efficacy was assessed by 12-lead electrocardiography and 72-h Holter monitoring after 3, 6, 12, and 24 months. Recurrence was defined as AF/atrial flutter (AFL)/tachycardia (AT) recorded by electrocardiography or Holter monitoring lasting >30 s during 2-year follow-up. At 2-year follow-up, single and multiple procedure success rates were 67% and 82%, respectively. Two (4%) patients experienced a major complication (bleeding) requiring intervention following hybrid ablation. Among the 16 (33%) patients who experienced an AF/AFL/AT recurrence, 13 (81%) were ATs/AFLs and only 3 (19%) were AF. Repeat ablation was performed in 10 (20%) patients and resulted in sinus rhythm in 7 (70%) at 2-year follow-up. Conclusion First-line single-stage hybrid AF ablation is an effective treatment strategy for patients with persistent and long-standing persistent AF with an acceptable rate of major complications. Recurrences are predominantly AFL/AT that can be successfully ablated percutaneously. Hybrid ablation seems a feasible approach for first-line ablation of (long-standing) persistent AF.

Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis

“…The most common access was thorascopic (12 studies). Seven studies utilised a bilateral thorascopic approach [ 17 , 19 , 22 , 24 , 26 , 27 , 30 ]. The convergent procedure was performed in four studies via a subxiphoid laparoscopic approach [ 20 , 21 , 23 , 25 ].…”

Hybrid Ablation of Nonparoxysmal Atrial Fibrillation: The Convergent and Totally Thoracoscopic Approaches

“…Reported single hospitalization 1-year HRS rhythm success rates have ranged from 60% to 82% [14,25,[27][28][29][30][31]. De Asmundis et al [32] have also reported their extended 1, 2 and 3 year results of 82%, 79% and 79% respectively.…”

“…Reported single hospitalization 1-year HRS rhythm success rates have ranged from 60% to 82% [ 14 , 25 , 27 , 28 , 29 , 30 , 31 ]. De Asmundis et al .…”

“…[ 32 ] have also reported their extended 1, 2 and 3 year results of 82%, 79% and 79% respectively. While most series report that failures of treatment are mostly non-atrial fibrillation (i.e., atrial flutter and atrial tachyarryhtmias) [ 27 , 30 , 33 ], independent predictors of recurrence have included female gender, in-hospital atrial fibrillation [ 14 , 32 ], prolonged pre-op AF, and pre-op mitral regurgitation [ 14 ]. Attempts to restore normal sinus rhythm with repeat catheter ablations ranges from 1% [ 34 ] to 20% [ 27 ].…”

Hybrid atrial fibrillation ablation: long-term outcomes from a single-centre 10-year experience

“…This is consistent with previous literature from our group 10 and other groups. 26 Pison et al reported 87% of ATas free survival at 2 years follow-up. 13 However, 37.2% of patients had paroxysmal AF compared with 20.0% in the current study.…”