Cor Vasa 2017, 59(4):e345-e352 | DOI: 10.1016/j.crvasa.2017.05.004

Middle-term results of hybrid atrial fibrillation ablation using AtriCure system

Alan Bulava^a,b,c,*, Aleš Mokráček^c,d, Martin Eisenberger^a,c, Vojtěch Kurfirst^d, Ladislav Dušek^e

^a Kardiologické oddělení, Kardiocentrum, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika

^b Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

^c Zdravotně sociální fakulta Jihočeské univerzity, České Budějovice, Česká republika

^d Kardiochirurgické oddělení, Kardiocentrum, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika

^e Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity, Brno, Česká republika

Introduction: Long-term results of catheter ablation (CA) for persistent and long-standing persistent atrial fibrillation (AF) are disappointing. The hybrid approach is currently one of options for overcoming the limitations of CA.

Aim: To evaluate the safety and medium-term efficacy of the hybrid approach in patients with persistent and long-standing persistent AF.

Methods: All patients underwent epicardial thoracoscopic radiofrequency (RF) pulmonary vein (PV) isolation using the AtriCure clamp followed by left atrial (LA) linear lesions (using a linear pen), Marshall ligament disruption, and LA appendage exclusion using an AtriClip. All patients underwent an electrophysiological study (EPS) and RF CA 2-3 months after the initial surgery to eliminate recurrent conductions from/to the PVs or across the linear lesions, and to eliminate all spontaneous and inducible atrial arrhythmias. 7-Day ECG Holter monitoring was performed every 3 months during the first year and every 6 months afterwards to evaluate possible recurrent arrhythmias.

Results: Seventy patients (49 male, median 63.5 years) took part in the study. EPS was performed 87 days (median) after the thoracoscopic surgery. Seventy-six percent of patients were in normal sinus rhythm (SR) at the start of the EPS, 7% had typical atrial flutter, 11% had atrial tachycardia, and 6% were in AF. After completion of the hybrid approach, all PVs were isolated, while a complete conduction block across the linear lines was achieved in 88.6% of patients. Twelve months after the procedure, 77.1% of patients had a stable SR without any anti-arrhythmic medication or re-ablation. If we included those on anti-arrhythmic drugs and re-ablation procedures, SR was achieved in 96.5% of patients during follow-up (936 ± 432 days).

Conclusion: The sequential hybrid approach is probably the most effective and relatively safe invasive treatment for persistent and long-term persistent AF with very low medium- to long-term recurrences. Introduction of the hybrid approach to clinical practice requires extensive cooperation between cardiologic and cardiothoracic teams.

Keywords: Atrial fibrillation; Epicardial ablation; Hybrid approach; RF catheter ablation

Received: March 17, 2017; Accepted: May 3, 2017; Published: August 1, 2017  Show citation