Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial Fibrillation

Heijden, Claudia A. J. van der; Weberndörfer, Vanessa; Vroomen, Mindy; Luermans, Justin; Chaldoupi, Sevasti‐Maria; Bidar, Elham; Vernooy, Kevin; Pison, Laurent; Kuijk, Sander M J van; Meir, Mark La; Crijns, Harry J.G.M.; Maesen, Bart

doi:10.1016/j.jacep.2022.12.011

Cited by 40 publications

(34 citation statements)

References 19 publications

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“…The importance of achieving a durable transmural lesion set may be demonstrated in studies reporting sequential hybrid AF treatment protocol results. Touch-up catheter ablation of the incomplete surgical lesions led to excellent e cacy results both in observational and randomized studies [22][23][24]. Two small observational studies on hybrid procedures after the concomitant CryoMaze reported 86% overall freedom from AF/AT at 12 months [8] or 73% after a 10-year follow-up [25].…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological Findings in Patients Undergoing Surgical Cryo-ablation for Treatment of Atrial Fibrillation

Bulava,

Mokráček,

Němec

et al. 2024

Preprint

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Objectives Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation. Methods Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients were assigned to undergo radiofrequency catheter ablation (RFCA), i.e., hybrid treatment, as a part of the multicenter trial. Results We analyzed 103 patients who underwent RFCA 105±35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P=0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P=0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P=0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P <0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P <0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P=NS). Conclusions The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.

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Section: Discussionmentioning

confidence: 99%

Electrophysiological Findings in Patients Undergoing Surgical Cryo-ablation for Treatment of Atrial Fibrillation

Bulava,

Mokráček,

Němec

et al. 2024

Preprint

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“…In a recent small random study (HARTCAP-AF trial), 31.6% (6/19) of the hybrid ablation group needed endocardial touch-up to isolate the posterior wall and hybrid ablation (pulmonary vein and posterior wall isolation mandatory) showed better rhythm outcome compared with catheter ablation. 21 Considering these, a hybrid approach with testing and completing the posterior wall isolation might have an impact on the rhythm outcome.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of thoracoscopic ablation and radiofrequency catheter ablation for persistent atrial fibrillation as a de novo procedure

Kim

Jeong

et al. 2023

Europace

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Aims Limited data are available regarding the efficacy of thoracoscopic ablation as the first procedure for persistent atrial fibrillation (AF). We sought to compare the long-term efficacy of thoracoscopic ablation vs. radiofrequency (RF) catheter ablation as the first procedure for persistent AF. Methods and results Between February 2011 and December 2020, 575 patients who underwent ablation for persistent AF were studied. Among them, thoracoscopic ablation was performed in 281 patients, RF catheter ablation in 228, and hybrid ablation in 66. Rhythm, clinical, and safety outcomes during 7-year follow-up were compared. The patients who underwent thoracoscopic ablation were older, had a higher prevalence of stroke, and had a larger left atrial volume than those who underwent RF catheter ablation. In the propensity score-matched population (n = 306), incidences of atrial tachyarrhythmia recurrence were 51.4% in the thoracoscopic ablation group and 62.5% in the RF catheter ablation group [adjusted hazard ratio (HR) 0.869, 95% confidence interval (CI) 0.618–1.223, P = 0.420]. Stroke and total procedural adverse events were not significantly different between thoracoscopic and RF catheter ablation (2.7 vs. 2.5%, P = 0.603, and 7.1 vs. 4.8%, P = 0.374, respectively). The hybrid ablation group showed similar rhythm outcomes compared with both the thoracoscopic and the RF catheter ablation groups. At the redo procedure, pulmonary vein gaps were more frequently observed in the RF catheter ablation group (32.6%) than in the thoracoscopic ablation group (7.9%) and in the hybrid ablation group (8.8%) (P < 0.001). Conclusion As a first procedure in persistent AF, thoracoscopic ablation and RF catheter ablation showed comparable efficacy, clinical, and safety outcomes during long-term follow-up.

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“…A recent prospective, superiority, unblinded, randomized controlled trial comparing the effectiveness and safety of HA with CA in 41 ablation-naive patients with (longstanding)-PeAF highlighted higher freedom from atrial tachyarrhythmias off antiarrhythmic drugs in the HA group compared with the CA group (89% vs. 41%, p = 0.002), with comparable serious adverse event rates (21% vs. 14%, p = 0.685) and quality of life (QoL) scores between the two groups (p = 0.491) [29]. A meta-analysis by Shrestha et al investigating the effectiveness of Hybrid Convergent ablation in patients mostly with drug-refractory PeAF and long-standing PeAF noted that freedom from atrial arrhythmias was 69% (95% confidence interval [CI]: 61-78%, n = 523) and 50% (95% CI: 42-58%, n = 343) off antiarrhythmic drugs [30].…”

Section: The Advent Of Hybrid Endocardial/epicardial Ablationmentioning

confidence: 99%

Ablative Management of Persistent Atrial Fibrillation (PeAF) with Posterior Wall Isolation (PWI): Where Do We Stand?

Baqal

Masry

2023

JCDD

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Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial Fibrillation

Cited by 40 publications

References 19 publications

Electrophysiological Findings in Patients Undergoing Surgical Cryo-ablation for Treatment of Atrial Fibrillation

Electrophysiological Findings in Patients Undergoing Surgical Cryo-ablation for Treatment of Atrial Fibrillation

Long-term outcome of thoracoscopic ablation and radiofrequency catheter ablation for persistent atrial fibrillation as a de novo procedure

Ablative Management of Persistent Atrial Fibrillation (PeAF) with Posterior Wall Isolation (PWI): Where Do We Stand?

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