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Durable effectiveness and safety of hybrid ablation versus catheter ablation: 2-year results from the randomized CEASE-AF trial†

. 2025 Jul 01 ; 67 (7) : .

Language English Country Germany Media print

Document type Journal Article, Randomized Controlled Trial, Multicenter Study

Persistent link   https://www.medvik.cz/link/pmid40711852

Grant support
AtriCure, Inc

OBJECTIVES: The CEASE-AF trial demonstrated that epicardial-endocardial hybrid ablation (HA) had superior effectiveness compared to endocardial catheter ablation (CA) for non-paroxysmal atrial fibrillation (AF), without significantly increasing major complications during a 12-month period. Most contemporary AF ablation trials have not evaluated durability beyond 12 months. Therefore, 24-month effectiveness and safety of HA and CA are compared. METHODS: CEASE-AF is a prospective, multicentre, randomized trial. Patients 18-75 years of age with symptomatic, drug refractory persistent AF and left atrial diameter >4.0 cm or long-standing persistent AF were randomized 2:1 to HA (posterior wall and pulmonary vein isolation with left atrial appendage exclusion) or CA (pulmonary vein isolation). Secondary effectiveness was freedom from AF/atrial flutter/atrial tachycardia off class I/III anti-arrhythmic drugs except for those who previously failed at doses not exceeding those previously failed through a 24-month follow-up period. Major complications and reinterventions were evaluated. RESULTS: The intention-to-treat population was 102 patients with HA and 52 patients with CA. Seventy-five percent were male, 80.5% had persistent AF and 19.5% had long-standing persistent AF, with a mean age of 60.7 ± 7.9 years. Effectiveness for 24 months was 66.3% (63/95) with HA and 33.3% (17/51) with CA [absolute difference 33.0% (95% confidence interval 14.3%, 48.3%; P < 0.001)]. Major complication rates were 10.8% (11/102) with HA and 9.6% (5/52) with CA (P = 1.0), and fewer patients had reinterventions after HA than CA [18.9% (18/95) vs 52.9% (27/51), P < 0.001]. CONCLUSIONS: CEASE-AF demonstrated that the 32.4% absolute benefit of HA over CA for 12 months was durable for 24 months at 33% with continued similar safety rates and fewer reinterventions after HA (funded by AtriCure, Inc.; NCT02695277). CLINICALTRIALS.GOV REGISTRATION: NCT02695277.

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Joglar JA, Chung MK, Armbruster AL  et al.  2023 ACC/AHA/ACCP/HRS Guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation  2024;149:e1–156. PubMed PMC

Kirchhof P, Camm AJ, Goette A  et al. ; EAST-AFNET 4 Trial Investigators. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med  2020;383:1305–16. PubMed

Reddy VY, Gerstenfeld EP, Natale A  et al. ; ADVENT Investigators. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med  2023;389:1660–71. PubMed

Kuck KH, Brugada J, Furnkranz A  et al. ; FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med  2016;374:2235–45. PubMed

Duytschaever M, De Potter T, Grimaldi M  et al. ; inspIRE Trial Investigators. Paroxysmal atrial fibrillation ablation using a novel variable-loop biphasic pulsed field ablation catheter integrated with a 3-dimensional mapping system: 1-year outcomes of the multicenter inspIRE study. Circ Arrhythm Electrophysiol  2023;16:e011780. PubMed PMC

Mansour M, Calkins H, Osorio J  et al.  Persistent atrial fibrillation ablation with contact force-sensing catheter: the prospective multicenter PRECEPT trial. JACC Clin Electrophysiol  2020;6:958–69. PubMed

Verma A, Haines DE, Boersma LV  et al. ; PULSED AF Investigators. Pulsed field ablation for the treatment of atrial fibrillation: PULSED AF Pivotal Trial. Circulation  2023;147:1422–32. PubMed PMC

Lo M, Nair D, Mansour M  et al.  Contact force catheter ablation for the treatment of persistent atrial fibrillation: results from the PERSIST-END study. J Cardiovasc Electrophysiol  2023;34:279–90. PubMed

Su WW, Reddy VY, Bhasin K  et al. ; STOP Persistent AF Investigators. Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: results from the multicenter STOP Persistent AF trial. Heart Rhythm  2020;17:1841–7. PubMed

Sau A, Kapadia S, Al-Aidarous S  et al.  Temporal trends and lesion sets for persistent atrial fibrillation ablation: a meta-analysis with trial sequential analysis and meta-regression. Circ Arrhythm Electrophysiol  2023;16:e011861. PubMed PMC

Anter E, Mansour M, Nair DG  et al. ; SPHERE PER-AF Investigators. Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial. Nat Med  2024;30:2303–10. PubMed PMC

Chieng D, Sugumar H, Ling LH  et al.  Catheter ablation for persistent atrial fibrillation: a multicenter randomized trial of pulmonary vein isolation (PVI) versus PVI with posterior left atrial wall isolation (PWI)—the CAPLA study. Am Heart J  2022;243:210–20. PubMed

Turagam MK, Neuzil P, Schmidt B  et al.  Impact of left atrial posterior wall ablation during pulsed field ablation for persistent atrial fibrillation. J Am Coll Cardiol EP 2024;10:900–12. PubMed

Tsai TY, Lo LW, Cheng WH  et al.  10-year outcomes of patients with non-paroxysmal atrial fibrillation undergoing catheter ablation. Circ J  2022;87:84–91. PubMed

Winkle RA, Mead RH, Engel G  et al.  Very long term outcomes of atrial fibrillation ablation. Heart Rhythm  2023;20:680–8. PubMed

DeLurgio DB, Crossen KJ, Gill J  et al.  Hybrid convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation: results of CONVERGE clinical trial. Circ Arrhythm Electrophysiol  2020;13:e009288. PubMed

Doll N, Weimar T, Kosior DA  et al.  Efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: a randomised, controlled trial. EClinicalMedicine  2023;61:102052. PubMed PMC

van der Heijden CAJ, Weberndorfer V, Vroomen M  et al.  Hybrid ablation versus repeated catheter ablation in persistent atrial fibrillation: a randomized controlled trial. JACC Clin Electrophysiol  2023;9:1013–23. PubMed

Tzeis S, Gerstenfeld EP, Kalman J  et al.  2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace  2024;26;1–107.

Van Gelder IC, Rienstra M, Bunting KV  et al. ; ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J  2024;45:3314–414. PubMed

Pannone L, Mouram S, Della Rocca DG  et al.  Hybrid atrial fibrillation ablation: long-term outcomes from a single-centre 10-year experience. Europace  2023;25;1–9. PubMed PMC

Dunnington GH, Pierce CL, Eisenberg S  et al.  A heart-team hybrid approach for atrial fibrillation: a single-centre long-term clinical outcome cohort study. Eur J Cardiothorac Surg  2021;60:1343–50. PubMed

Sanchez-Somonte P, Kittichamroen N, Gao-Kang J  et al.  Incremental efficacy for repeat ablation procedures for catheter ablation of atrial fibrillation: 5-year follow-up. JACC Adv  2024;3:101200. PubMed PMC

Verma A, Jiang CY, Betts TR  et al. ; STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med  2015;372:1812–22. PubMed

William J, Chieng D, Curtin AG  et al.  Radiofrequency catheter ablation of persistent atrial fibrillation by pulmonary vein isolation with or without left atrial posterior wall isolation: long-term outcomes of the CAPLA trial. Eur Heart J  2025;46:132–43. PubMed

Tung R, Burris R, Salazar P, Aziz Z.  Human recordings of left atrial epicardial-endocardial asynchrony during persistent atrial fibrillation. Circ Arrhythm Electrophysiol  2022;15:e010605. PubMed

Nakamura K, Sasaki T, Minami K  et al.  Incidence, distribution, and electrogram characteristics of endocardial-epicardial connections identified by ultra-high-resolution mapping during a left atrial posterior wall isolation of atrial fibrillation. J Interv Card Electrophysiol  2024;67:773–84. PubMed

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