Two-staged hybrid treatment of persistent atrial fibrillation: short-term single-centre results

Kurfirst, Vojtěch; Mokráček, Aleš; Bulava, Alan; Čanádyová, Júlia; Haniš, Jiří; Pešl, Ladislav

doi:10.1093/icvts/ivt538

Cited by 62 publications

(66 citation statements)

References 22 publications

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“…The studies of Bulava et al [27] and Kurfirst et al [28] are considered overlapping; of these two, Bulava et al comprises the most recent study and encloses the biggest population. The same accounts for two articles written by La Meir et al [29, 30], one by Kumar et al [31], and one by Pison et al [32], compared to a larger study by Pison et al [15].…”

Section: Resultsmentioning

confidence: 99%

Hybrid ablation for atrial fibrillation: a systematic review

Vroomen

Pison

2016

J Interv Card Electrophysiol

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PurposeHybrid ablation for AF is performed in a growing number of centers. Due to absence of guidelines, operative approaches and perioperative care differ per center. In this review, an overview of findings from published studies on hybrid ablations is given, and related topics are discussed (e.g., one- and two-stage approaches, lesion sets, and patient management).MethodsA systematic literature search was performed in the PubMed and Embase databases. All identified articles were screened and checked for eligibility by the two authors.ResultsTwelve studies describing a total of 563 patients were selected. Due to substantial differences in approaches (one-stage, two-stage, sequential), surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal, transabdominal), energy sources (unipolar, bipolar), lesion sets (applying left or right atrial lesions), periprocedural care and endpoints (monitoring, definition of recurrence), and success rates (sinus rhythm after a mean of 26 months) are difficult to compare and varied from 27 % (without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies using bipolar devices, success rates with the use of antiarrhythmic drugs were at least 71 %. Major complications such as bleeding, sternotomy, and death occurred in 7 % of the total population (of which ten complications, 16 %, occurred in the concomitant cardiac surgery hybrid group).ConclusionThe field of AF ablation has dramatically changed over the past years, with one of the most recent developments the hybrid AF ablation. Lack of matching data hinders drawing conclusions and creating guidelines. Early results however are encouraging. More data are awaiting and needed.

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Section: Resultsmentioning

confidence: 99%

Hybrid ablation for atrial fibrillation: a systematic review

Vroomen

Pison

2016

J Interv Card Electrophysiol

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“…It is also possible to ablate arrhythmia triggers and inducible atrial tachycardias after the surgical ablation; these would otherwise be left untreated. Studies published to date included simultaneous or sequential hybrid procedures with reported success rates from 83–94 %, but the experience has only been with bipolar or monopolar radiofrequency energy [12–15]. 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.…”

Section: Discussionmentioning

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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“…Minimally invasive approaches have also been utilized in conjunction with treatment for AF, with bilateral video-assisted thoracoscopic pulmonary vein isolation, atrial ganglia ablation, ligament of Marshall division and LAA staple excision, with a reported success rate of 50 -90% in maintaining sinus rhythm for paroxysmal AF, 30 -85% for persistent AF and 30 -75% for long-standing persistent AF, [117][118][119] and up to 90% if followed by a "touch-up" catheter ablation procedure. 120 The effects on stroke risk reduction of these hybrid approaches is currently unknown.…”

Section: Minimally Invasive and Hybrid Surgical Approachesmentioning

confidence: 99%