Key result
Prior catheter ablation linked to ~266% higher AF recurrence risk following totally thoracoscopic ablation.
Why the study?
To evaluate the efficacy and safety of totally thoracoscopic ablation in patients with recurrent AF after radiofrequency catheter ablation.
Does totally thoracoscopic ablation (TTA) improve freedom from atrial arrhythmias in patients with recurrent atrial fibrillation and a history of prior catheter ablation compared to those without prior ablation?
Cohort (n=460)
No
Does totally thoracoscopic ablation (TTA) improve freedom from atrial arrhythmias in patients with recurrent atrial fibrillation and a history of prior catheter ablation compared to those without prior ablation?
Effect estimate: HR 3.661 (95% CI 2.247-5.963)
Absolute Event Rate: 31.2% vs 68.4%
p-value: p=<0.001
Totally thoracoscopic ablation is safe but less effective for maintaining long-term sinus rhythm in patients with recurrent atrial fibrillation who have a history of prior catheter ablation compared to those without prior ablation.
Caution advised using TTA after prior ablation; observational data leaves open optimal strategy and needs RCTs.
Background:The objective of this study was to evaluate the efficacy and safety of totally thoracoscopic ablation (TTA) in patients with recurrent atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).Methods: From February 2012 to May 2020, 460 patients who underwent TTA were classified into two groups: CA (presence of RFCA history, n = 74) and nCA groups (absence of RFCA history, n = 386).Inverse probability of treatment weighting (IPTW) analyses were used to adjust for confounders.The primary endpoint was freedom from the composite of AF, typical atrial flutter, atypical atrial flutter and any atrial tachyarrhythmia, lasting more than 30 seconds during the follow-up.All patients were followed up at 3, 6, and 12 months via electrocardiogram and 24-hour Holter monitoring.Results: Bilateral pulmonary vein isolation (PVI) was conducted in all patients and the conduction block tests were confirmed.In the CA group, difficult PVI occasionally occurred due to structural changes, such as pericardial adhesion and fibrosis of the pulmonary venous structure, caused by a previous catheter ablation.Early complications such as stroke and pacemaker insertion were not different between the two groups.The normal sinus rhythm was maintained in 70.1% (317/460) patients after a median follow-up period of 38.1 months.The IPTW-weighted Kaplan-Meier curves revealed that freedom from AF events at 5 years was 68.4% (95% confidence interval, 62.8-74.5) in the nCA group and 31.2%(95% confidence interval, 16.9-57.5)in the CA group (P < 0.001).In IPTW-weighted Cox regression, preoperative left atrial diameter, persistent or long-standing AF, the presence of congestive heart failure and catheter ablation history were associated with AF events.Conclusion: Patients in the CA group showed a higher recurrence rate of AF than those in the nCA group, while TTA was safely performed in both the groups.
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Lim et al. (2023) conducted a cohort in Recurrent Atrial Fibrillation (n=460). Totally thoracoscopic ablation (TTA) with prior catheter ablation vs. Totally thoracoscopic ablation (TTA) without prior catheter ablation was evaluated on Freedom from the composite of AF, typical atrial flutter, atypical atrial flutter and any atrial tachyarrhythmia lasting more than 30 seconds (HR 3.661, 95% CI 2.247-5.963, p=<0.001). Totally thoracoscopic ablation resulted in a significantly lower 5-year freedom from atrial fibrillation events in patients with prior catheter ablation (31.2%) compared to those without prior ablation (68.4%, HR 3.661).
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