The Efficacy and Safety of Hybrid Ablations for Atrial Fibrillation
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
34217655
DOI
10.1016/j.jacep.2021.04.013
PII: S2405-500X(21)00424-2
Knihovny.cz E-resources
- Keywords
- atrial fibrillation, brain magnetic resonance imaging, hybrid ablation, implantable loop recording, neurocognitive examination, thoracoscopic ablation,
- MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Atrial Fibrillation * drug therapy surgery MeSH
- Catheter Ablation * adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Tachycardia, Supraventricular * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Anti-Arrhythmia Agents MeSH
OBJECTIVES: This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations. BACKGROUND: Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited. METHODS: Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions. RESULTS: Fifty-nine patients (age: 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60.0% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI: 41.3-66.8) at 1 year and 43.8% (95% CI: 30.7-57.0) at 2 years. CONCLUSIONS: The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.
References provided by Crossref.org
Catheter ablation for non-paroxysmal atrial fibrillation. A review
Diagnosis of Ischemic Stroke: As Simple as Possible
