AI Article Synopsis
- Totally thoracoscopic (TT) epicardial ablation combined with endocardial catheter ablation is an emerging method for treating persistent atrial fibrillation (AF).
- A study analyzed 83 patients who underwent either staged or same-day TT hybrid ablation, finding a recurrence rate of 29% at a median of 147 days, with longstanding persistent AF being the main predictor of recurrence.
- Although the staged approach revealed more incomplete pulmonary vein isolations (PVI), it did not affect the timing of AF/AT recurrences compared to simultaneous procedures.
Article Abstract
Introduction: Totally thoracoscopic (TT) epicardial ablation combined with endocardial catheter ablation is an emerging treatment for persistent AF. The effects of timing of the TT and endocardial portion on AT/AF recurrence are not known.
Methods: We retrospectively analyzed patients undergoing TT staged versus simultaneous hybrid AF ablation at our institution. Arrhythmia-free outcome was compared using time to recurrence (AF or AT greater than 30 seconds after a 3-month blanking period from endocardial ablation) at 12 months. All subjects had continuous ILR or PM monitoring.
Results: Eighty-three patients (52 same-day, 31 staged) underwent TT hybrid AF ablation. Recurrence was observed in 23 (29%) patients at a median time of 147 days (IQR 91,238). In univariate analysis, a staged approach significantly increased the likelihood of detecting incomplete PVI (OR 6 [95% CI 2-17] P = 0.001). However, only longstanding persistent AF (LSP-AF) status predicted recurrence (HR 4 [95% CI 1.4-12] P = 0.01). Neither a staged approach (HR 1.0 [95% CI 0.4-2.4] P = 0.9), nor detection of incomplete PVI (HR 0.9 [95% CI 0.4-2.3] P = 0.8) predicted time to first AF/AT recurrence.
Conclusions: Staged hybrid ablation of AF significantly increases the likelihood of discovering incomplete PVI at the time of endocardial mapping versus a same-day procedure. However, the staged approach did not improve time to first AT/AF recurrence.
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| http://dx.doi.org/10.1111/jce.12906 | DOI Listing |
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