Staged hybrid procedure versus radiofrequency catheter ablation in the treatment of atrial fibrillation

The treatment effect of the hybrid procedure, consisting of a thoracoscopic ablation followed by an endocardial radiofrequency catheter ablation (RFCA), is unclear. A total of 117 ablation-naïve patients who underwent either the staged hybrid procedure (n = 72) or RFCA alone (n = 105) for drug-refractory, non-valvular persistent or long-standing persistent atrial fibrillation (AF) were enrolled. The primary outcome is occurrence of total atrial arrhythmia, defined as a composite of AF, sustained atrial tachycardia (AT), and atypical atrial flutter (AFL) after index procedure. The mean age was 52.7 years. Eighty-four percentage of the patients were male. Patients with prior history of stroke and long-standing persistent AF were more prevalent in the hybrid group than RFCA group. The left atrial volume index was larger in the hybrid group (P<0.001). During 2.1 years of median follow-up, the incidence of total atrial arrhythmia was not different between the two groups (32.5% vs. 35.7%; adjusted hazard ratio: 0.64; 95% confidence interval: 0.36-1.14; P = 0.13). The AF recurrence was significantly lower in the hybrid group than in the RFCA group (29.6% vs. 34.9%; adjusted HR: 0.53; 95% CI: 0.29-0.99; P = 0.046). The hospital stay was longer in the hybrid group than in the RFCA group (11 days vs. 4 days; P<0.001). A staged hybrid procedure may be an alternative choice for drug-refractory persistent AF, but it is no more effective than RFCA alone to eliminate atrial arrhythmias. Considering the long-length of stay and the morbidity, careful consideration should be given in selection of treatment strategy.