Key result
Hybrid AF ablation achieved an overall mid-term freedom from atrial fibrillation of 74.6% at a mean follow-up of 31.5 months.
Why the study?
AF affects 33 million people worldwide, and there was a need to summarize the literature reporting mid-term freedom from AF following hybrid ablation.
Does hybrid AF ablation improve mid-term freedom from AF in patients with atrial fibrillation?
Meta-Analysis (n=1,242)
Does hybrid AF ablation improve mid-term freedom from AF in patients with atrial fibrillation?
Effect estimate: 74.64% (95% CI 67.01-81.61)
Hybrid AF ablation demonstrates a 74.6% mid-term freedom from AF at a mean follow-up of 31.5 months, with a low overall complication rate.
Supports hybrid ablation for mid-term AF control; extends pooled outcome data to guide practice and future trials.
INTRODUCTION: Atrial Fibrillation (AF) is a common tachyarrhythmia affecting 33 million people worldwide. Hybrid AF ablation utilises a surgical (epicardial) ablation followed by an endocardial catheter-based ablation. The aim of this systematic review and meta-analysis is to summarize the literature reporting mid-term freedom from AF following hybrid ablation. METHODS: An electronic search of databases was performed to identify all relevant studies providing mid-term (2 year) outcomes following hybrid ablation for AF. The primary study outcome was to assess the mid-term freedom from AF following hybrid ablation, utilising the metaprop function on Stata® (Version 17.0, StataCorp, Texas, USA). Subgroup analysis was performed to assess the impact of various operative characteristics on mid-term freedom from AF. The secondary outcomes assessed mortality and procedural complication rate. RESULTS: The search strategy identified 16 studies qualifying for inclusion in this meta-analysis, with 1242 patients in total. The majority of papers were retrospective cohort studies (15) and one study was a randomized control trial (RCT). The mean follow up was 31.5 ± 8.4 months. Following hybrid ablation, the overall mid-term freedom from AF was 74.6% and 65.4% for patients off antiarrhythmic drugs (AAD). Actuarial freedom from AF was 78.2%, 74.2% and 73.6% at 1, 2 and 3 years respectively. No significant differences in mid-term freedom from AF based epicardial lesion set (box vs pulmonary vein isolation) or Left atrial appendage/Ganglionated Plexus/Ligament of Marshall ablation or staged vs concomitant procedures. There were 12 deaths overall following the hybrid procedure with a pooled complication rate of 5.53%. CONCLUSION: Hybrid AF ablation offers promising mid-term freedom from AF reported at a mean follow-up of 31.5 months. The overall complication rate remains low. Further analysis of high-quality studies with randomized data and long-term follow up will help verify these results.
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Eranki et al. (2023) conducted a meta-analysis in Atrial Fibrillation (n=1,242). Hybrid AF ablation was evaluated on Mid-term freedom from atrial fibrillation (74.64%, 95% CI 67.01-81.61). Hybrid AF ablation achieved an overall mid-term freedom from atrial fibrillation of 74.6% at a mean follow-up of 31.5 months.
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