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Staged Hybrid Approach For Treatment Of Persistent Atrial Fibrillation: One-year Results of Hybrid Procedure Versus Catheter Ablation
Hyoung Woo Chang, Dong Seop Jeong, Seung-Jung Park, Young Keun On, June Soo Kim, Young Tak Lee, Pyo Won Park.
Samsung Medical Center, Seoul, Korea, Republic of.

OBJECTIVE: Thoracoscopic ablation following post-procedural endocardial confirmation (staged hybrid) overcomes the limitations of both techniques for treatment of atrial fibrillation (AF). We compared one-year results of staged hybrid procedure with catheter ablation in persistent AF patients.
METHODS: From 2010 to 2013, 118 patients who underwent staged hybrid procedure (Hybrid group, n=54) or catheter ablation (Ablation group, n=64) for persistent AF were prospectively enrolled. Thoracoscopic ablation included pulmonary vein isolation, gangilonated plexus ablation, division of Marshall ligament and resection of left atrial appendage. An electrophysiologic study was performed on postoperative 4th day. All patients underwent 24-hour holter monitoring at 3, 6, and 12 months.
RESULTS: No intergroup difference was observed in preoperative characteristics (Table). During post-procedural confirmation, additional endocardial ablations were required in 11 patients (20%). Residual potentials were primarily found in superior ridge of upper pulmonary veins and inferior ridge of the right lower pulmonary vein (14 of 21 sites, 66.7%). In the hybrid group, 50 patients (92.5%) showed normal sinus rhythm, and freedom from AF recurrence without antiarrhythmic drugs was 55.7±7.6% at one year. Freedom from AF recurrence at one year was higher in the hybrid group (Figure). In overall populations, ablation only was an independent predictor for AF recurrence (p=0.015, hazard ratio (HR) =3.9, 95% confidence interval (CI) =1.3-11.5). In the hybrid group, independent predictors for AF recurrence were CHAD2 score (p=0.011, HR=3.4, 95% CI=1.4-8.8) and absence of sinus conversion during thoracoscopic ablation (p=0.018, HR=36.0, 95% CI=1.9-690).
CONCLUSIONS: The success of the hybrid group at one year was superior to the ablation group. We suggest that the hybrid procedure could be considered as a primary treatment in persistent AF patients.
Preoperative parameters
VariableHybrid (N=54)Ablation (N=64)P value
Gender (male)3 (6%)12 (19%)0.050
AF duration44±4335±340.148
LA volume index43±1543±120.764
CHAD2 score >114 (26%)9 (14%)0.105

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