Key result
Simultaneous hybrid ablation for therapy-resistant atrial fibrillation maintained sinus rhythm in 80% of patients over 24 months, with a 9% procedural complication rate.
Why the study?
Hybrid ablation is used for therapy-resistant symptomatic AF, prompting an evaluation of the efficacy, safety, and factors determining success and quality of life of simultaneous hybrid ablation in non-paroxysmal AF.
Does simultaneous hybrid ablation prevent arrhythmia recurrence in patients with therapy-resistant atrial fibrillation?
Cohort (n=56)
Does simultaneous hybrid ablation prevent arrhythmia recurrence in patients with therapy-resistant atrial fibrillation?
Simultaneous hybrid ablation is highly effective for therapy-resistant atrial fibrillation, maintaining sinus rhythm in 80% of patients over 24 months, though with a 9% complication rate.
Supports feasibility of hybrid ablation in resistant non-paroxysmal AF; hypothesis-generating and requires randomized validation.
Background A hybrid technique using thoracoscopic epicardial and standard endocardial ablation of atrial fibrillation (AF) is a strategy used to treat AF patients with therapy-resistant symptomatic AF. We conducted comparative study of efficacy and safety of simultaneous hybrid ablation in patients with non-paroxysmal forms of AF and evaluated the factors that determine success and quality of life. Methods The study included 56 consecutive patients who underwent simultaneous hybrid ablation. First, epicardial ablation was performed using thoracoscopic access: to isolate the pulmonary veins and the posterior wall of the left atrium. After this, an endocardial electrophysiological assessment was carried out from the pulmonary veins to the left atrium and additional endocardial ablation was performed, where necessary. The next day, a loop ECG recorder was implanted subcutaneously in the thoracic region. Efficiency was evaluated using implanted loop ECG recorders. The average follow up was 24 months, the studied patients came to the clinic every 3 months to receive diagnostic reports from loop recorders. Recurrence was defined as AF, atrial flutter and other atrial tachycardia, recorded in reports of loop recorders lasting >30 sec during follow up period. Results Continuous follow up was carried out in 56 patients, the average age of which was 57±9 years. Of these, 39 (70%) men, 6 (10%) paroxysmal, 38 (68%) persistent and 12 (22%) long-standing persistent AF. Within 24 months of follow up, 45 (80%) maintened a sinus rhythm. Most recurrenses were atrial flutter (8/11 patients). Success was associated with factors such as left atrial size, patient age and duration of arrhythmia. Patients with paroxysmal AF had the highest success, patients with long-standing persistent AF had the least success. 5 (9%) patients had complications associated with the procedure. Quality of life after ablation improved in patients with sinus rhythm. Conclusion The efficiency of simultaneuous hybrid AF ablation was 80% for 24 months of continuous follow up period associated with the type of AF. Quality of life improved significantly, complications associated with the procedure occurred in 9%.
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Baimbetov et al. (2020) conducted a cohort in Therapy-resistant symptomatic atrial fibrillation (n=56). Simultaneous hybrid ablation was evaluated on Maintenance of sinus rhythm (absence of AF, atrial flutter, or other atrial tachycardia lasting >30 sec). Simultaneous hybrid ablation for therapy-resistant atrial fibrillation maintained sinus rhythm in 80% of patients over 24 months, with a 9% procedural complication rate.
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