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
Language English Country Netherlands Media print-electronic
Document type Journal Article
Grant support
16-32478A
Ministerstvo Zdravotnictví Ceské Republiky
PubMed
28921386
DOI
10.1007/s10840-017-0286-y
PII: 10.1007/s10840-017-0286-y
Knihovny.cz E-resources
- Keywords
- Atrial fibrillation, Hybrid ablation, Long-standing persistent, Persistent, Versapolar device,
- MeSH
- Equipment Safety MeSH
- Time Factors MeSH
- Chronic Disease MeSH
- Equipment Design MeSH
- Electrocardiography, Ambulatory methods MeSH
- Electrocardiography methods MeSH
- Atrial Fibrillation diagnostic imaging surgery MeSH
- Risk Assessment MeSH
- Catheter Ablation instrumentation methods MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Monitoring, Physiologic instrumentation methods MeSH
- Follow-Up Studies MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
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.
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