Hybrid ablation resulted in a higher rate of freedom from atrial tachyarrhythmias off antiarrhythmic drugs compared with catheter ablation (89% vs 41%, P=0.002).
RCT (n=41)
unblinded
randomized
Does hybrid ablation improve freedom from atrial tachyarrhythmias compared to catheter ablation in ablation-naive patients with persistent atrial fibrillation?
Hybrid ablation significantly improves 12-month freedom from atrial tachyarrhythmias compared to catheter ablation in patients with persistent atrial fibrillation, with a comparable rate of serious adverse events.
Absolute Event Rate: 89% vs 41%
p-value: p=0.002
BACKGROUND: Although catheter ablation (CA) is successful for the treatment of paroxysmal atrial fibrillation (AF), results are less satisfactory in persistent AF. Hybrid ablation (HA) results in better outcomes in patients with persistent atrial fibrillation (persAF), as it combines a thoracoscopic epicardial and transvenous endocardial approach in a single procedure. OBJECTIVES: The purpose of this study was to compare the effectiveness and safety of HA with CA in a prospective, superiority, unblinded, randomized controlled trial. METHODS: Forty-one ablation-naive patients with (long-standing)-persAF were randomized to HA (n = 19) or CA (n = 22) and received pulmonary vein isolation, posterior left atrial wall isolation and, if needed, a cavotricuspid isthmus ablation. The primary efficacy endpoint was freedom from any atrial tachyarrhythmia >5 minutes off antiarrhythmic drugs after 12 months. The primary and secondary safety endpoints included major and minor complications and the total number of serious adverse events. RESULTS: After 12 months, the freedom of atrial tachyarrhythmias off antiarrhythmic drugs was higher in the HA group compared with the CA group (89% vs 41%, P = 0.002). There was 1 pericarditis requiring pericardiocentesis and 1 femoral arteriovenous-fistula in the HA group. In the CA arm, 1 bleeding from the femoral artery occurred. There were no deaths, strokes, need for pacemaker implantation, or conversions to sternotomy, and the number of (serious) adverse events was comparable between groups (21% vs 14%, P = 0.685). CONCLUSIONS: Hybrid AF ablation is an efficacious and safe procedure and results in better outcomes than catheter ablation for the treatment of patients with persistent AF. (Hybrid Versus Catheter Ablation in Persistent AF HARTCAP-AF; NCT02441738).
Heijden et al. (Wed,) conducted a rct in persistent atrial fibrillation (n=41). Hybrid ablation vs. Catheter ablation was evaluated on freedom from any atrial tachyarrhythmia >5 minutes off antiarrhythmic drugs after 12 months (p=0.002). Hybrid ablation resulted in a higher rate of freedom from atrial tachyarrhythmias off antiarrhythmic drugs compared with catheter ablation (89% vs 41%, P=0.002).