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2015 ; 4
(3
): e001754
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Sequential hybrid procedure for persistent atrial fibrillation
#MMPMID25809548
Bulava A
; Mokracek A
; Hanis J
; Kurfirst V
; Eisenberger M
; Pesl L
J Am Heart Assoc
2015[Mar]; 4
(3
): e001754
PMID25809548
show ga
BACKGROUND: Catheter ablation of persistent atrial fibrillation yields an
unsatisfactorily high number of failures. The hybrid approach has recently
emerged as a technique that overcomes the limitations of both surgical and
catheter procedures alone. METHODS AND RESULTS: We investigated the sequential
(staged) hybrid method, which consists of a surgical thoracoscopic radiofrequency
ablation procedure followed by radiofrequency catheter ablation 6 to 8 weeks
later using the CARTO 3 mapping system. Fifty consecutive patients (mean age 62±7
years, 32 males) with long-standing persistent atrial fibrillation (41±34 months)
and a dilated left atrium (>45 mm) were included and prospectively followed in an
unblinded registry. During the electrophysiological part of the study, all 4
pulmonary veins were found to be isolated in 36 (72%) patients and a complete
box-lesion was confirmed in 14 (28%) patients. All gaps were successfully
re-ablated. Twelve months after the completed hybrid ablation, 47 patients (94%)
were in normal sinus rhythm (4 patients with paroxysmal atrial fibrillation
required propafenone and 1 patient underwent a redo catheter procedure). The
majority of arrhythmias recurred during the first 3 months. Beyond 12 months,
there were no arrhythmia recurrences detected. The surgical part of the procedure
was complicated by 7 (13.7%) major complications, while no serious adverse events
were recorded during the radiofrequency catheter part of the procedure.
CONCLUSIONS: The staged hybrid epicardial-endocardial treatment of long-standing
persistent atrial fibrillation seems to be extremely effective in maintenance of
normal sinus rhythm compared to radiofrequency catheter or surgical ablation
alone. Epicardial ablation alone cannot guarantee durable transmural lesions.
CLINICAL TRIAL REGISTRATION: URL: www.ablace.cz Unique identifier:
cz-060520121617.
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