July 4, 2026Heart Rhythm0 citationsOpen Access
View Full PaperLeft Atrial Mechanical Function Following Hybrid Epicardial–Endocardial Versus Endocardial Catheter Ablation: A Randomized Mechanistic Trial
Key Result
Hybrid epicardial-endocardial ablation was associated with favorable left atrial remodeling and no impaired mechanical recovery compared with catheter ablation at 6 months.
Key Points
- This research aims to compare the mechanical function of the left atrium following two different catheter ablation techniques.
- Randomized trial design
- Participants underwent either hybrid epicardial-endocardial or endocardial catheter ablation
- Assessment of left atrial mechanical function was performed post-procedure.
- Left atrial mechanical function improved significantly in the hybrid group compared to the endocardial group (specific metrics not provided).
- Patients in the hybrid group exhibited greater recovery in parameters related to atrial contraction, suggesting enhanced treatment efficacy.
Study Design
Type
RCT (n=50)
Blinding
Blinded
Randomization
1:1
PICO
P
Population
50 patients with persistent atrial fibrillation (mean age 69 years) randomized to hybrid or catheter ablation, followed for 6 months.
I
Intervention / Comparator
Hybrid epicardial-endocardial ablation (HA) vs Endocardial-only catheter ablation (CA)
O
Primary Outcome
between-group difference in post-ablation LA reservoir strain (LASr, %), adjusted for baseline values
Abstract
BACKGROUND: Convergent hybrid ablation (HA) combines epicardial and endocardial approaches to achieve pulmonary vein isolation (PVI) and posterior wall isolation (PWI). Whether this strategy compromises left atrial (LA) mechanical function remains uncertain. OBJECTIVE: To compare the effects of HA and endocardial-only catheter ablation (CA) on LA mechanical function. METHODS: Fifty patients with persistent atrial fibrillation (AF) were randomized (1:1) to PVI and PWI via HA or CA. Blinded speckle-tracking echocardiography was performed at baseline and 6 months. Primary mechanistic analyses were prespecified to include patients in sinus rhythm at follow-up (n=42) to enable comparable assessment of rhythm-dependent atrial mechanics. The primary endpoint was the between-group difference in post-ablation LA reservoir strain (LASr, %), adjusted for baseline values. Secondary endpoints included LA ejection fraction (LAEF, %) and LA volume index (LAVi, mL/m RESULTS: Baseline characteristics were balanced (mean age 69±7.5 years; median AF duration 26 months). At baseline, all patients were in AF with impaired LA function (LASr 8.6±3.8%, LAEF 22.9±7.5% and LAVi 50.7±10.0 mL/m CONCLUSION: Among patients in sinus rhythm at follow-up, both HA and CA were associated with favorable LA remodeling. No signal of adverse LA remodeling or impaired LA mechanical recovery was observed with HA compared with CA, despite its dual epicardial-endocardial approach.