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Staged hybrid ablation for persistent and longstanding persistent atrial fibrillation effectively restores sinus rhythm in long-term observation.

Authors :
Zembala M
Filipiak K
Kowalski O
Buchta P
Niklewski T
Nadziakiewicz P
Koba R
Gąsior M
Kalarus Z
Zembala M
Source :
Archives of medical science : AMS [Arch Med Sci] 2017 Feb 01; Vol. 13 (1), pp. 109-117. Date of Electronic Publication: 2016 May 05.
Publication Year :
2017

Abstract

Introduction: Hybrid ablation (HABL) of atrial fibrillation combining endoscopic, minimally invasive, closed chest epicardial ablation with endocardial CARTO-guided accuracy was introduced to overcome the limitations of current therapeutic options for patients with persistent (PSAF) and longstanding persistent atrial fibrillation (LSPAF). The purpose of this study was to evaluate the procedural safety and feasibility as well as effectiveness of HABL in patients with PSAF and LSPAF 1 year after the procedure.<br />Material and Methods: The study is a single-center, prospective clinical registry. From 07/2009 to 12.2014, 90 patients with PSAF ( n = 39) and LSPAF ( n = 51), at the mean age of 54.8 ±9.8, in mean EHRA class 2.6, underwent HABL. 64.4% of patients had a history of prior cardioversion or catheter ablation. Thirteen patients had LVEF less than 35%. Mean AF duration was 4.5 ±3.7 years. Patients were scheduled for 3-, 6- and 12-month follow-up with 7-day Holter monitoring.<br />Results: At 6 months after the procedure 78% (54/69) of patients were in SR. At 12 months after the procedure 86% (59/69) were in SR and 62.3% (43/69) in SR and off class I/III antiarrhythmic drugs (AADs). Only 1% (1/69) of patients required a repeat ablation for atrial flutter. A significant decrease in LA dimension and an increase in LVEF were noted.<br />Conclusions: A combination of epicardial and endocardial RF ablation should be considered as a treatment option for patients with persistent and long-standing persistent atrial fibrillation as it is safe and effective in restoring sinus rhythm.<br />Competing Interests: Michal Zembala MD PhD served as a consultant (proctor) for nContact Inc. from January 2012 until January 2013. Other authors report no conflicts of interests. No corporate funding supported the study. The Reveal XT implantable loop monitors were purchased from funds received from the Polish Society of Cardiology/Servier Prize for the Best Research Proposal in 2011.

Details

Language :
English
ISSN :
1734-1922
Volume :
13
Issue :
1
Database :
MEDLINE
Journal :
Archives of medical science : AMS
Publication Type :
Academic Journal
Accession number :
28144262
Full Text :
https://doi.org/10.5114/aoms.2015.53960