Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center

• DOI: 10.1111/jce.12926
• Publication Date: 2016-01-14T15:56:58Z
• Authors: ZACHARY EDGERTON; ALESSANDRO PAOLET...; RODNEY HORTON; CHINTAN TRIVEDI; PASQUALE SANTANGELI; RONG BAI; CAROLA GIANNI; SANGHAMITRA MOHANTY; J. DAVID BURKHARDT; G. JOSEPH GALLING...; JAVIER E. SANCHEZ; SHANE BAILEY; MAEGEN LANE; LUIGI DI BIASE; FRANCESCO SANTORO; JUSTIN PRICE; ANDREA NATALE
• Keywords: Concomitant; Single Center; Stroke

Hybrid versus Endocardial Ablation for LSPAF Introduction of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in treatment AF, either by surgical or percutaneous approach. Objective We investigated difference success and complication rates between combined epicardial endocardial catheter ablation our standard procedure. Methods Results Twenty‐four consecutive patients (group 1) with enlarged left atrium (>4.5 cm) underwent a procedure, consisting surgical, closed‐chest, epicardial, radiofrequency (nContact, NC, USA) via pericardial access, concomitant (hybrid procedure). Procedural complications long‐term outcomes were compared to those 35 who refused hybrid only 2). Baseline characteristics comparable. In group 1, 1 patient (4.2%) developed post‐procedural cardio‐embolic stroke 3 (12.5%) died (1 atrio‐esophageal fistula, fatal stroke, unknown cause early follow‐up), while no strokes deaths occurred 2. Overall higher (P = 0.036). At 24‐month follow‐up, 4 (19%) 19 (54.3%) 2 arrhythmia‐free after single on off antiarrhythmic drugs (P<0.001). Total procedural time (276.9 ± 63.5 vs. 203.15 67.3 minutes) length hospital stay (5 [IQR 3–8] 1–3] days significantly shorter <0.001). Conclusions atrium, surgical/endocardial approach increases rate does not improve when extensive only.