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

BULAVA, Alan, Ales MOKRACEK, Martin EISENBERGER, Vojtech KURFIRST and Ladislav DUŠEK. Middle-term results of hybrid atrial fibrillation ablation using AtriCure system. Cor et Vasa. AMSTERDAM: ELSEVIER SCIENCE BV, 2017, vol. 59, No 4, p. "E345"-"E352", 8 pp. ISSN 0010-8650. Available from: https://dx.doi.org/10.1016/j.crvasa.2017.05.004.

Basic information

Original name

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

Authors

BULAVA, Alan (203 Czech Republic), Ales MOKRACEK (203 Czech Republic), Martin EISENBERGER (203 Czech Republic), Vojtech KURFIRST (203 Czech Republic) and Ladislav DUŠEK (203 Czech Republic, guarantor, belonging to the institution)

Edition

Cor et Vasa, AMSTERDAM, ELSEVIER SCIENCE BV, 2017, 0010-8650

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Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

RIV identification code

RIV/00216224:14110/17:00098097

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.crvasa.2017.05.004

UT WoS

000410033600011

Keywords in English

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

Tags

EL OK

Tags

International impact, Reviewed

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Abstract

V originále

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. (C) 2017 The Czech Society of Cardiology. Published by Elsevier Sp. zo.o. All rights reserved.