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Minimally Invasive Surgical Ablation versus Catheter Ablation for Lone Atrial Fibrillation. Results from the STANDARD Study
Giuseppe Nasso1, Vito Romano1, Mario Siro Brigiani1, Raffaele Bonifazi1, Francesco Bartolomucci2, Giuseppe Speziale1.
1Division of Cardiac Surgery, Anthea Hospital, GVM Hospitals of Care and Research, Bari, Italy, 2Division of Cardiology, "L. Bonomo" Hospital, Andria, Italy.

OBJECTIVE:
To compare the clinical and instrumental results of catheter ablation (CA) vs. those of the minimally invasive, epicardial surgical ablation (SA) in the treatment of isolated atrial fibrillation (AF).
METHODS: We reviewed the records of patients who underwent either SA or CA in the 2008-2012 period. After propensity-matching, we obtained two groups of 202 patients each. A longitudinal follow-up was performed.
RESULTS: There was no periprocedural mortality in both Groups. The rate of periprocedural morbidity was comparable among the Groups (2.5%). At the follow-up (average 36 ± 11 months), one major difference emerged among Groups in the rate of recurrence of AF, which was 10.9% in the SA Group vs. 30.2% in the CA Group, p<0.001), irrespective to the preoperative type of AF (paroxysmal or persisting). The survival free from the composite endpoint (including recurrent symptoms of atrial tachyarrhythmia, thromboembolic events, new ablation procedure, cardioversion and new hospitalization for atrial tachyarrhythmia) was significantly lower in the CA Group (p<0.001, Kaplan-Meier analysis). Persisting type of AF, increased preoperative left atrial dimension and obesity independently predicted the recurrence of AF in both the study Groups. Nonetheless, the outcome of patients in the SA Group was not affected by the duration of AF history (Kaplan-Meier analysis).
CONCLUSIONS: Both the treatment strategies under investigation (CA and SA) met the safety endpoint in the treatment of lone AF. Nevertheless, the surgical ablation appears to yield better results at mid-term follow-up in terms of arrhythmia recurrence, particularly in selected cases having paroxysmal AF and longer history of AF.


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