Key result
Sequential hybrid ablation achieved stable sinus rhythm without antiarrhythmic drugs in 77.1% of patients with persistent and long-standing persistent atrial fibrillation at 12 months.
Why the study?
Does sequential hybrid ablation improve sinus rhythm maintenance in patients with persistent and long-standing persistent atrial fibrillation?
Observational (n=70)
No
Does sequential hybrid ablation improve sinus rhythm maintenance in patients with persistent and long-standing persistent atrial fibrillation?
A sequential hybrid ablation approach is highly effective for maintaining sinus rhythm in patients with persistent and long-standing persistent atrial fibrillation.
Hybrid ablation shows mid-term feasibility and safety in persistent AF; leaves open efficacy versus catheter ablation in randomized trials.
Ăvod: LĂŠÄba perzistujĂcĂ a dlouhodobÄ perzistujĂcĂ fibrilace sĂnĂ (FS) katetrizaÄnĂ ablacĂ v dlouhodobĂŠm horizontu selhĂĄvĂĄ. Jednou ze souÄasnĂ˝ch moĹžnostĂ, jak pĹekonat limitace katetrizaÄnĂ ablace, je hybridnĂ pĹĂstup.CĂl: Zjistit bezpeÄnost a stĹednÄdobou ĂşspÄĹĄnost lĂŠÄby pacientĹŻ s perzistujĂcĂ a dlouhodobÄ perzistujĂcĂ FS hybridnĂ metodou.Metody: Pacienti podstoupili epikardiĂĄlnĂ thorakoskopickou radiofrekvenÄnĂ (RF) izolaci plicnĂch Ĺžil (PĹ˝) za pomoci kleĹĄĹĽovĂŠho instrumentĂĄria AtriCure, kterĂĄ byla doplnÄna vytvoĹenĂm lineĂĄrnĂch lĂŠzĂ v levĂŠ sĂni (LS) pomocĂ lineĂĄrnĂho pera, disrupcĂ Marshallova ligamenta a exkluzĂ ouĹĄka LS pomocĂ speciĂĄlnĂho klipu (AtriClip). S odstupem dvou aĹž tĹĂ mÄsĂcĹŻ po vĂ˝konu podstoupili vĹĄichni pacienti elektrofyziologickĂŠ vyĹĄetĹenĂ (EFV) a RF katetrizaÄnĂ ablaci s cĂlem endokardiĂĄlnÄ eliminovat pĹĂpadnĂŠ recidivy elektrickĂŠho vedenĂ do/z PĹ˝ nebo napĹĂÄ lineĂĄrnĂmi lĂŠzemi a eliminovat vĹĄechny spontĂĄnnĂ i inducibilnĂ sĂĹovĂŠ arytmie. V nĂĄslednĂŠm obdobĂ byly recidivy arytmiĂ hodnoceny pomocĂ sedmidennĂho holterovskĂŠho monitorovĂĄnĂ provĂĄdÄnĂŠho v prvnĂm roce kaĹždĂŠ tĹi mÄsĂce a nĂĄslednÄ kaĹždĂ˝ch ĹĄest mÄsĂcĹŻ.VĂ˝sledky: Do studie bylo zaĹazeno celkem 70 pacientĹŻ (49 muŞů, mediĂĄn 63,5 roku). ElektrofyziologickĂŠ vyĹĄetĹenĂ bylo provedeno za 87 dnĹŻ (mediĂĄn) od primĂĄrnĂho thorakoskopickĂŠho vĂ˝konu. Ĺ estasedmdesĂĄt procent pacientĹŻ mÄlo v dobÄ EFV normĂĄlnĂ sinusovĂ˝ rytmus (SR), 7 % typickĂ˝ flutter sĂnĂ, 11 % sĂĹovou tachykardii a 6 % FS. VĂ˝sledkem dokonÄenĂŠho hybridnĂho pĹĂstupu byla izolace vĹĄech PĹ˝ v 100 % pĹĂpadĹŻ a dosaĹženĂ blokĂĄdy vedenĂ napĹĂÄ vĹĄemi zamýťlenĂ˝mi lineĂĄrnĂmi lĂŠzemi u 88,6 % pacientĹŻ. Po 12 mÄsĂcĂch od zĂĄkroku bylo stabilnĂho SR dosaĹženo u 77,1 % pacientĹŻ bez jakĂŠkoliv antiarytmickĂŠ lĂŠÄby Äi reablacĂ. RacionĂĄlnĂ kontroly arytmie bylo dosaĹženo u 95,5 % pacientĹŻ po prĹŻmÄrnou dobu sledovĂĄnĂ 936 ± 432 dnĹŻ.ZĂĄvÄr: SekvenÄnĂ hybridnĂ pĹĂstup pĹedstavuje v souÄasnĂŠ dobÄ patrnÄ nejĂşÄinnÄjĹĄĂ a po pĹekonĂĄnĂ uÄebnĂ kĹivky i bezpeÄnou metodu invazivnĂ lĂŠÄby perzistujĂcĂ a dlouhodobÄ perzistujĂcĂ FS s extrĂŠmnÄ nĂzkĂ˝m poÄtem recidiv arytmie ve stĹednÄdobĂŠm horizontu po zĂĄkroku. ZavedenĂ hybridnĂch pĹĂstupĹŻ do klinickĂŠ praxe vyĹžaduje nutnost komplexnĂ spoluprĂĄce kardiologickĂŠho a kardiochirurgickĂŠho tĂ˝mu.
No takes yet. Share an insight, caveat, or question.
Bulava et al. (2017) conducted an observational in Persistent and long-standing persistent atrial fibrillation (n=70). Sequential hybrid ablation (epicardial thoracoscopic RF ablation followed by endocardial RF catheter ablation) was evaluated on Stable sinus rhythm without antiarrhythmic medication or re-ablation at 12 months. Sequential hybrid ablation achieved stable sinus rhythm without antiarrhythmic drugs in 77.1% of patients with persistent and long-standing persistent atrial fibrillation at 12 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: