Could the Hybrid Treatment of Persistent AF be as Effective as Simultaneous "Dallas lesion set" in CABG Patients?

Aleksei Kovalev ¹, Andrey Filatov ¹, Sergey Kovalev ², Denis Gryaznov ², Leo Bockeria ¹

¹ A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia; ² Voronezh state clinical hospital, regional cardiac surgery center, Voronezh, Russia;

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–C

Abstract

Objectives. The aims of the study were to evaluate the efficacy and safety of hybrid epi-endocardial “Dallas lesion pattern” and to compare it with standard Dallas procedure in persistent AF patients with CAD and simultaneous CABG.

Methods:The two-center clinical cohort study was held in 2012-2016 and includes 126 patients with CAD and persistent AF. All patients underwent CABG procedure. The first group (66 patient) also passed through simultaneous MAZE procedure via “Dallas lesion pattern”. In the second group (60 patients) endocardial ablation with the help of electroanatomical voltage and CFAE mapping was held not later than 3 months after CABG, simultaneous epicardial PVI and LAA ligation. Follow-up was 3 years. All patients were on AAT and OAC for minimum 6 months after the procedure.

Results: The mean dLA were 4,68 cm² and 4,59 cm². The total percentage of PV reconduction was 23,3%. in the second group. Hospital efficacyin group 1 was 87,8% (58 patients), in group 2 - 81,6% (49 patients). In the end of follow-up period efficacy was 83,3% and 76,6% respectively (p=0,522); cumulative HR was 0,99 (0,64;2,05) and 1,2 (0,77;2,73); NYHA I-II was in 70,7% and 68,4%; freedom from TIA was 96,9% (OR 1,5 (0,6;34,51)) and 95% (OR 3,14 (0,83;62,14)). Total mortality was 0,79%.

Conclusion: Hybrid two-step approach is as effective as standard “Dallas lesion pattern” in patients with CAD and CABG procedure with the same number of observed complications and no mortality.