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.
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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.
Other information
Original language English
Type of outcome Article in a journal
Field of Study 30201 Cardiac and Cardiovascular systems
Country of publisher Netherlands
Confidentiality degree is not subject to a state or trade secret
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
Changed by Changed by: Soňa Böhmová, učo 232884. Changed: 22/3/2018 16:34.
Abstract
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.
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