Sequential Hybrid Surgical CryoMaze and Transvenous Catheter Ablation of Atrial Fibrillation

Eisenberger, Martin; Bulava, Alan; Mokráček, Aleš; Haniš, Jiří; Kurfirst, Vojtěch; Dušek, Ladislav

doi:10.1111/pace.12686

Cited by 7 publications

(31 citation statements)

References 23 publications

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“…Both surgical access and ablation lesion sets varied among the studies, with interpretation of the lesion set from published figures required in one study (Table 2). 8 Surgical access was via unilateral or bilateral VATS (n ¼ 13), 6,[9][10][11][12][13][14][15][16][17][18][19][20] subxiphoid/transdiaphragmatic laparoscopy (n ¼ 6), 8,[21][22][23][24][25] sternotomy (n ¼ 2), 26,27 and minithoracotomy (n ¼ 1). 28 pulmonary vein isolation (PVI) in 11, 8,13,[15][16][17]19,[22][23][24]26,28 and box isolation in 11 6,[9][10][11][12]14,18,20,21,25,27 ; additional lesions are detailed in Table 2: roof line, floor line, mitral isthmus line, ganglionated plexi ablation, ligament of Marshall ablation, between th...…”

Section: Surgical Ablation Proceduresmentioning

confidence: 99%

Hybrid ablation for atrial fibrillation: A systematic review and meta-analysis

et al. 2021

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Background: Both catheter and surgical ablation strategies offer effective treatments of atrial fibrillation (AF). The hybrid (joint surgical and catheter) ablation for AF is an emerging rhythm control strategy. We sought to determine the efficacy and safety of hybrid ablation of AF.Methods: Systematic review and meta-analysis interrogating PubMed, EMBASE, and Cochrane databases from January 1, 1991, to November 30, 2017, using the following search terms: "Cox-maze," "mini-maze," "ablation methods (including radiofrequency, cryoablation, cryomaze)," and "surgery." Included studies required ablation procedures to be hybrid and report rhythm follow-up.Results: We included 925 patients with AF (38% persistent, 51% longstanding persistent) from 22 single-center studies (mean follow-up of 19 months). The surgical lesion set consisted of pulmonary vein isolation (n ¼ 11) or box lesion (n ¼ 11) with variable additional linear ablation. This was followed by sequential (n ¼ 9), staged (n ¼ 9), or combination (n ¼ 4) catheter-based ablation to ensure isolation of pulmonary veins and to facilitate additional ablation or consolidation of surgically ablated lines. Overall, sinus rhythm maintenance was 79.4% (95% confidence interval [CI], 72.4-85.7] and 70.7% (95% CI, 62.2-78.7) with and without antiarrhythmic drugs, respectively at 19 AE 25 (range, 6-128) months. The use of the bipolar AtriCure Synergy system and left atrial appendage exclusion conferred superior rhythm outcome without antiarrhythmic drugs (P .01). The overall complication rate was 6.

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Section: Surgical Ablation Proceduresmentioning

confidence: 99%

Hybrid ablation for atrial fibrillation: A systematic review and meta-analysis

et al. 2021

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“…The only report on hybrid ablations with cryoenergy used during the surgical part of the procedure revealed an overall freedom from atrial tachyarrhythmias to be 86 % at 12 months. The overall success rate at 1 year can reach 94 % if patients on antiarrhythmic drugs or patients who underwent a successful re-do ablation are not excluded as a failure [10]. There is certainly reporting bias among published studies, as several large studies of hybrid AF ablation, including the staged Dual Epicardial Endocardial Persistent (DEEP) AF study, FAST-II, and SCALA have not yet been published.…”

Section: Discussionmentioning

confidence: 99%

“…In a non-randomized study, sequential surgical CryoMaze procedures followed by catheter ablation led to high freedom from arrhythmia in patients with persistent and long-standing persistent AF and without an increase in complications [10]. However, there have been no randomized clinical trials conducted to evaluate whether the hybrid approach is superior to a CryoMaze procedure alone; therefore, a recommendation regarding the best procedure for all patients is unavailable.…”

Section: Introductionmentioning

confidence: 99%

Sequential Hybrid CryoMaze Ablation versus Surgical CryoMaze Alone for the Treatment of Atrial Fibrillation (SurHyb): study protocol for a randomized controlled trial

Eisenberger

Bulava

Kautzner

et al. 2016

Trials

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BackgroundAtrial fibrillation is common in patients with structural heart disease who are undergoing cardiac surgery. Surgical CryoMaze has been shown to be an effective treatment in several trials, but success rates have varied considerably, between 47–95 %. The sequential hybrid approach, combining surgical CryoMaze followed by radiofrequency catheter ablation, can achieve high freedom from atrial arrhythmias, even when rigorous methods to detect arrhythmias after the procedure are used. However, data from randomized trials comparing hybrid ablations to surgical ablations alone are lacking.Methods/DesignThe SurHyb study is a prospective, multicenter, randomized study. Patients with persistent or long-standing persistent atrial fibrillation will be randomized to either surgical CryoMaze alone or surgical CryoMaze followed by catheter ablation 3 months post-surgery. The primary outcome measure is arrhythmia-free survival without class I or III antiarrhythmic drugs, which will be evaluated using 7-day ECG Holter monitoring at 24 months. A total of 260 patients will be investigated from three medical centers in the Czech Republic to obtain the relevant information.DiscussionThis is the first randomized study that compares surgical CryoMaze alone with the staged hybrid surgical CryoMaze followed by catheter ablation in patients with persistent or long-standing persistent atrial fibrillation. These results will contribute to the optimization of the treatment for these patients.Trial registrationCzech Clinical Trials Registry, cz-301020151253. Registered on 30 October 2015.

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“…With this background, in this issue of Pacing and Clinical Electrophysiology, Eisenberger et al report their experience using a sequential hybrid approach to AF ablation combining a surgical CryoMaze procedure in the operating room and followed by delayed radiofrequency (RF) catheter ablation in the electrophysiology laboratory. 6 Thirty-five patients with persistent AF underwent a CryoMaze procedure in conjunction with cardiac surgery for structural heart disease. Three months after surgery, all patients underwent electrophysiological study and electroanatomical mapping of the left and right atria with RF ablation to reisolate all PVs with intact electrical conduction.…”

Section: Ablation Surgery Trialsmentioning

confidence: 99%

“…With this background, in this issue of Pacing and Clinical Electrophysiology , Eisenberger et al. report their experience using a sequential hybrid approach to AF ablation combining a surgical CryoMaze procedure in the operating room and followed by delayed radiofrequency (RF) catheter ablation in the electrophysiology laboratory …”

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confidence: 93%