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Sequential hybrid ablation vs. surgical CryoMaze alone for treatment of atrial fibrillation: results of multicentre randomized controlled trial
A. Bulava, D. Wichterle, A. Mokráček, P. Osmančík, P. Budera, P. Kačer, L. Vetešková, P. Němec, T. Skála, P. Šantavý, J. Chovančík, P. Branny, V. Rizov, M. Kolesár, I. Šafaříková, M. Rybář, SURHYB Trial Investigators
Language English Country England, Great Britain
Document type Randomized Controlled Trial, Multicenter Study, Journal Article
Grant support
NV19-02-00046
Ministry of Health of the Czech Republic
NLK
Free Medical Journals
from 1999 to 1 year ago
PubMed Central
from 2008
Open Access Digital Library
from 1999-01-01
Medline Complete (EBSCOhost)
from 1999-01-01
Oxford Journals Open Access Collection
from 1999-01-01
- MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Atrial Fibrillation * diagnosis surgery drug therapy MeSH
- Catheter Ablation * adverse effects methods MeSH
- Hemorrhage MeSH
- Humans MeSH
- Recurrence MeSH
- Tachycardia, Supraventricular * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
AIMS: Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation alone. METHODS AND RESULTS: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either radiofrequency catheter ablation [Hybrid Group (HG)] or no further treatment (Surgery Group). The primary efficacy endpoint was the first recurrence of AF/AT without class I or III antiarrhythmic drugs as assessed by implantable cardiac monitors. The primary clinical endpoint was a composite of hospitalization for arrhythmia recurrence, worsening of heart failure, cardioembolic event, or major bleeding. We analysed 113 and 116 patients in the Hybrid and Surgery Groups, respectively, with a median follow-up of 715 (IQR: 528-1072) days. The primary efficacy endpoint was significantly reduced in the HG [41.1% vs. 67.4%, hazard ratio (HR) = 0.38, 95% confidence interval (CI): 0.26-0.57, P < 0.001] as well as the primary clinical endpoint (19.9% vs. 40.1%, HR = 0.51, 95% CI: 0.29-0.86, P = 0.012). The trial groups did not differ in all-cause mortality (10.6% vs. 8.6%, HR = 1.17, 95%CI: 0.51-2.71, P = 0.71). The major complications of catheter ablation were infrequent (1.9%). CONCLUSION: Pre-emptively performed catheter ablation after the CryoMaze procedure was safe and associated with higher freedom from AF/AT and improved clinical outcomes.
Cardilogy Department Hospital Agel Třinec Podlesí Třinec Czechia
Cardilogy Department Masaryk Hospital Ústí nad Labem Czechia
Cardiology Department Institute for Clinical and Experimental Medicine Prague Czechia
Centre of Cardiovascular Surgery and Transplantation Brno Czechia
Faculty of Biomedical Engineering Czech Technical University Prague Kladno Czechia
Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc Olomouc Czechia
References provided by Crossref.org
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