Hybrid Ablation Versus Catheter Ablation for Persistent Atrial Fibrillation: Meta-Analysis

Introduction: The standard management of persistent atrial fibrillation remains inconclusive. Medical management involving rate control strategies remains the first choice, and interventional procedures involving pulmonary vein isolation and ablation of the ectopic foci is the choice of management following failure of medical therapy. Catheter ablation (CA) is an effective treatment strategy for paroxysmal atrial fibrillation but has limited effectiveness in the management of persistent AF. Hybrid ablation, which involves combining a thoracoscopic epicardial and transvenous endocardial approach to ablate pulmonary veins, has proved to be effective in recent randomised control trials. This meta-analysis aims to compare the effectiveness of HA and CA in managing persistent atrial fibrillation. Methodology This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of PubMed, Google Scholar, and EMBASE identified studies that compared the effectiveness of hybrid ablation with catheter ablation in the management of persistent atrial fibrillation was included. Three randomised control trials were included in the final analysis based on multiple inclusion and exclusion criteria. The meta-analysis was conducted in R using the meta, metafor, and metadata packages. Pooled risk ratios (RR) were calculated using the Mantel-Haenszel method for common-effect models and inverse-variance methods for random-effects models. Continuous outcomes were analysed using pooled mean differences (MD). ResultsThe systematic review and meta-analyses conducted included a total of 3 randomised control trials, including 223 patients in the hybrid ablation group and 125 patients in the catheter ablation group. Freedom from persistent arrhythmia following discontinuation of AAD therapy was considered as the primary outcome. The odds of freedom from arrhythmic events were higher in the HA group (3.65 (1.64:8.17) and I 2 = 57.1%). The risk of major adverse events was statistically insignificant in both the groups. The procedure time was significantly higher in the HA group considering its level of complexity. Conclusion: In patients with persistent atrial fibrillation, hybrid ablation was associated with significantly greater freedom from recurrent atrial arrhythmias after discontinuation of anti-arrhythmic drug therapy compared with catheter ablation. Despite longer procedural times, the incidence of major adverse events was comparable between treatment strategies. These findings support hybrid ablation as a potentially more effective rhythm-control approach for persistent atrial fibrillation, although larger randomized studies with extended follow-up are warranted to better define its long-term efficacy and safety.