Two-year follow-up of one-stage left unilateral thoracoscopic epicardial and transcatheter endocardial ablation for persistent and long-standing persistent atrial fibrillation

Asmundis, Carlo de; Varnavas, Varnavas; Sieira, Juan; Ströker, Erwin; Coutiño, Henrique E.; Terasawa, Muryo; Abugattas, Juan-Pablo; Salghetti, Francesca; Maj, Riccardo; Guimarães, Osório Thiago; Iacopino, Saverio; Umbrain, Vincent; Poelaert, Jan; Brugada, Pedro; Gelsomino, Sandro; Chierchia, Gian‐Battista; Meir, Mark La

doi:10.1007/s10840-019-00616-w

Cited by 17 publications

(15 citation statements)

References 29 publications

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“…Our results are noteworthy for persistent and long-standing persistent AF patients given the lower predictive value of nonpersistent AF and lower rates of ablation success in prior studies. 29,30 Our analysis of 12-month outcomes also aligns with recent similar studies by de Asmundis et al and Maesen et al 22,23 This is important, as we are a large-volume center with experienced operators performing the hybrid procedure and our population reported is roughly double that of both similar papers, further validating their results. We also have the additional benefit of prior ablation Kaplan-Meier curve analysis, but we caution that the numbers may not be high enough to see a difference statistically between the two groups, as discussed henceforth.…”

Section: Arrhythmia-free Survival Outcomessupporting

confidence: 89%

“…32 A recent similar study from de Asmundis and colleagues reported that about half of the AFL recurrences involve the mitral isthmus line. 22 Similarly, at our center, AFL accounted for 53% of recurrences, and of those, 50% were perimitral or had a perimitral component, verifying further that the mitral isthmus is a difficult area to ablate.…”

Section: Mode Of Recurrence and Initial Intervention Following Hybridsupporting

confidence: 64%

“…19 The hybrid approach was shown to be successful in the challenging setting of persistent or long-standing persistent AF, and a study by our center demonstrated that patients receiving the hybrid procedure had fewer repeat ablations and less recurrence at 16 months. 20 It has been shown that atrial flutter (AFL) encompasses approximately half of recurrences when simple endocardial ablation techniques are used; [21][22][23] furthermore, treating recurring AF in this population can be relatively challenging. 24 Thus, our center sought to characterize arrhythmia recurrence after hybrid ablation in the setting of persistent and long-standing persistent AF.…”

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confidence: 99%

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Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

Kress

Erickson

Mengesha

et al. 2020

Journal of Patient-Centered Research and Reviews

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Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. Purpose It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF. Methods Patients with persistent AF (N=108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of atrial flutter or AF was determined with ambulatory monitoring (n=22) or electrocardiogram analysis (n=86) at each follow-up visit. Recurrence mode was confirmed by electrophysiology study for those patients undergoing subsequent catheter ablation after hybrid ablation. Results Patients were followed for a mean ± standard deviation of 25 ± 14 months. Of patients who had a recurrence, 53% (n=33) were in atrial flutter and 47% (n=29) were in AF. Of those who had a recurrence with atrial flutter, 14 received repeat ablation for either left (n=11) or left/right (n=3) atrial flutter and 3 received AF ablation. Half of ablations for atrial flutter recurrence following the hybrid procedure involved the mitral isthmus. Conclusions Atrial flutter accounts for about half of arrhythmia recurrences post-hybrid ablation. If catheter ablation of the mitral isthmus is considered during the hybrid procedure to prevent subsequent occurrence of perimitral flutter, bidirectional block must be performed to ensure a complete line of block.

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Section: Arrhythmia-free Survival Outcomessupporting

confidence: 89%

Section: Mode Of Recurrence and Initial Intervention Following Hybridsupporting

confidence: 64%

mentioning

confidence: 99%

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Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

Kress

Erickson

Mengesha

et al. 2020

Journal of Patient-Centered Research and Reviews

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“…In general, there are some safety considerations for unilateral thoracoscopic hybrid ablation with respect to the potential for prolonged unilateral lung ventilation, duration of hospital stay, and occurrence of common complications such as pleuropericarditis. 51 Preliminary outcomes from a randomised trial comparing thoracoscopic hybrid ablation with catheter ablation were recently reported. 52 In 41 patients, 83% of patients who received hybrid ablation were free from atrial arrhythmias without AADs at 12 months compared with 45% who received endocardial catheter ablation (p=0.015), with a similar quality of life and no reported increase in major adverse events in the hybrid group.…”

Section: Hybrid Thoracoscopic Ablationmentioning

confidence: 99%

A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

Kaba

Ahmed

Behr

et al. 2022

Arrhythm Electrophysiol Rev

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The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the recent hybrid convergent approach, and provides a summary of the associated outcomes.

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“…DeGroot reported in a Letter-to-the-Editor that 88% of their 66 patients were in sinus rhythm at 5 years, though only 55% of them had not experienced a recurrence of AF during the 5-year follow-up. Recently, LaMeir has reported a hybrid technique in which he performs the entire TT procedure through the left chest [ 88 ]. He reports a success rate of 68.8% at a mean follow-up of 24.9 + 11.8 months in 51 patients.…”

Section: Current Status Of Surgical Ablation For Stand-alone Afmentioning

confidence: 99%

Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

McCarthy

Cox

Kislitsina

et al. 2021

JCM

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Atrial fibrillation (AF) is the most common of all cardiac arrhythmias, affecting roughly 1% of the general population in the Western world. The incidence of AF is predicted to double by 2050. Most patients with AF are treated with oral medications and only approximately 4% of AF patients are treated with interventional techniques, including catheter ablation and surgical ablation. The increasing prevalence and the morbidity/mortality associated with AF warrants a more aggressive approach to its treatment. It is the purpose of this invited editorial to describe the past, present, and anticipated future directions of the interventional therapy of AF, and to crystallize the problems that remain.

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Two-year follow-up of one-stage left unilateral thoracoscopic epicardial and transcatheter endocardial ablation for persistent and long-standing persistent atrial fibrillation

Cited by 17 publications

References 29 publications

Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

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