Comparative Effectiveness of Hybrid Ablation Versus Endocardial Catheter Ablation Alone in Patients With Persistent Atrial Fibrillation.

Objectives: The outcomes of hybrid ablation versus endocardial catheter ablation alone were evaluated in patients with persistent and long-standing persistent atrial fibrillation (AF).

Background: Variable outcomes exist following endocardial catheter ablation in medically refractory patients with persistent AF. A hybrid epicardial-endocardial approach has emerged as an alternative to endocardial ablation.

Methods: In 133 consecutive patients, 69 received endocardial ablation alone (pulmonary vein isolation and radiofrequency catheter ablation [endo group]) and 64 received endocardial catheter ablation and epicardial ablation (hybrid group). Recurrence was defined as any arrhythmia following the 3-month blanking period.

Results: Patients were followed for a median of 16 months. The hybrid and endo groups were similar in age (61 ± 10 years vs. 62 ± 8 years), body mass index (35 ± 6 kg/m vs. 35 ± 7 kg/m), CHAD-VASc score (2 ± 1 vs. 2 ± 1), and ejection fraction (54 ± 11% vs. 53 ± 8%). The hybrid group had longer AF duration (median [interquartile range (IQR)] (12 months [IQR: 8 to 28 months] vs. 7 months [IQR: 5 to 12 months]; p < 0.001) and more previous ablations (58% vs. 25%; p < 0.001). Both groups had similar antiarrhythmic drug use at follow-up (55% vs. 48%). The hybrid group was less likely to have recurrence (37% vs. 58%; p = 0.013) and repeat ablation (9% vs. 26%; p = 0.012), and had an AF-free survival of 72% versus 51% (p = 0.01).

Conclusions: Among patients with persistent AF, hybrid ablation is associated with less AF recurrence and fewer re-do ablations. Prospective large-scale randomized trials are needed to validate these results.