Published in:
01-11-2017
Midterm outcomes of two-staged hybrid ablation of persistent and long-standing persistent atrial fibrillation using the versapolar epicardial surgical device and subsequent catheter ablation
Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2017
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Purpose
Hybrid ablation of atrial fibrillation (AF) is a promising treatment strategy for patients with non-paroxysmal AF, although, data regarding mid-term outcomes are limited.
Methods
Patients with persistent or long-standing persistent AF were enrolled. Initially, a thoracoscopic, right-sided, epicardial ablation was performed, with a goal of creating a box lesion on the posterior wall of the left atrium; a novel versapolar radiofrequency (RF) catheter was used. In patients enrolled later, occlusion of the left atrial appendage was also performed. An endocardial procedure was performed 2–4 months later, with the goal of confirming/completing the box lesion and ablating the ganglionated plexi and cavotricuspid isthmus. Efficacy was assessed using multiple 24-h and 1-week Holter monitoring. Analysis was performed to search for variables associated with procedure’s failure.
Results
Forty-one patients (14 persistent and 27 long-standing persistent AF) were enrolled with a mean AF duration of 33.5 ± 33.1 months. Mean follow-up was 507.2 ± 201.1 days (180–731). At the last follow-up visit, 27(65%) patients were arrhythmia-free, without anti-arrhythmics or need for re-ablation. Additional 4 patients (9.8%) were in sinus rhythm (SR) following re-ablation of postprocedural peri-mitral flutter and 4 (9.8%) were in SR on anti-arrhythmics. Longer periods of preoperative AF were independently associated with worse arrhythmia-free survival (p = 0.015). Serious postoperative complications occurred in 3 (7.3%) patients; only 1 (2.4%) patient had clinical consequences after 6 months.
Conclusions
Hybrid ablation of non-paroxysmal AF using a novel, versapolar RF device yields promising mid-term results. Better arrhythmia-free survival rates were found in AF patients with shorter AF duration.