Two-staged hybrid ablation of persistent long-standing atrial fibrillation

Oleg Y. Pidanov ¹, Natalia A. Kolomeychenko ¹, Artem V. Sveshnikov ², Oleg V. Sapelnikov ³, Anton S. Vorobiev ²

¹ Clinical Hospital of the Presidential Administration, Moscow, Russia; ² National Medical Surgical Center, Moscow, Russia; ³ National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow, Russia;

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – A

Abstract

OBJECTIVES:Hybrid ablation is a promising treatment strategy especially in patients with persistent long-standing (PLS) atrial fibrillation (AF); however, it’s not clear how to perform hybrid procedures, simultaneously or staged, for all patients or only in patients with recurrent of arrhythmia. The data regarding its efficacy and safety are still limited.

METHODS: Fifty-nine patients (47 male and 12 female) with PLSl  AF were enrolled. Mean age 54,5±9,9 years. History of AF was 6,1± 5 years. Mean size of left atrium was 45,5±4,7 mm. First, a totally thoracoscopic epicardial ablation with left atrial appendage closure/resection was performed. Electrophysiological evaluation and catheter ablation were performed 2-3 months later, with the goal of verifying or completing (if needed) the left atrial lesion and ablation of the cavotricuspid isthmus. Outcomes were assessed using 24-h Holter monitoring, repeated echocardiography.

RESULTS:The surgical procedure according to Dallas Lesion Set was successfully completed in 54 patients; “box lesion set” was performed in 5 patients. LAA closure/resection performed by surgical stapler or AtriClip. Mean time of procedure was 141,3±33,3 min. No mortality was in this group. One patient was needed conversion in sternotomy.Fifty-four patients (91,5%) was AF free at the end of thoracoscopic procedure and 53 patients (89,8%) was AF free at discharge, but 6 patients (10,2%) has atrial flutter. Effectiveness of surgical ablation was 79,6%. During 3 months after thoracoscopic procedures 8 patients underwent electrophysiological evaluation and catheter ablation. The gaps in left atrial ablation lines was closed in 4 patients; cavotricuspid isthmus ablation was performed in 7 patients. After 6 months, the effectiveness of two stage hybrid ablation was 86,7%.

CONCLUSION:Hybrid ablation is an effective treatment strategy for patients with PLS AF. Over 80% of patients were arrhythmia-free 6 months after the procedure. Catheter based procedures were necessary only for limited group of patients mainly for atrial flutter treatment.