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Initial Results of a Two-staged Hybrid Procedure in Patients with Longstanding Persistent Atrial Fibrillation.
Niels Verberkmoes, Khibar Salah, Daily Krijnen, Sabine Eijsbouts, Pepijn van de Voort, Bart van Straten.
Catharina Hospital, Eindhoven, Netherlands.

OBJECTIVE: Two-staged hybrid procedure combines a bilateral totally thoracoscopic maze procedure (TT-maze) followed by endocardial transcatheter ablation if required. We present our initial results with this treatment strategy in patients with longstanding persistent atrial fibrillation (LSPAF).
METHODS: Study population consisted of patients with symptomatic LSPAF (mean duration 3.6 ± 2.8 years) who underwent a TT-maze procedure between August 2013 and July 2015. TT-maze consisted of bilateral pulmonary vein isolation, roof and floor lesions, trigone line, ganglionated plexi ablation and left atrial appendage amputation. Endocardial transcatheter ablation was performed within 90 days in patients with recurrent arrhythmias. Primary endpoints were sinus rhythm (SR) and freedom from symptoms at 90 and 180 days post TT-maze. Follow-up was performed by ECG and Holter monitoring.
RESULTS: From 51 patients, 33 were male, median age 63 years (IQR 56-70), mean BMI 29.5 ± 4.0 kg/m2 and mean left atrial volume index 41.8 ± 11.5. Seventeen (33.3%) patients had a history of previous endocardial ablation. Surgical complications were perioperative bleeding (n=2, 3.9%), pacemaker implantation (n=1, 2.0%), pulmonary vein stenosis (n=1, 2.0%) and pneumothorax (n=4, 7.8%). No deaths or thromboembolic events occurred. Subsequently, 7 patients (13.7%) underwent endocardial ablation as part of the treatment strategy. Complete follow-up at 90 and 180 days were respectively 98% and 76% with respectively 80% (n=40/50) and 85% (n=33/39) of patients in SR.
CONCLUSIONS: The collaborative approach to the treatment of atrial fibrillation between cardiac surgeons and electrophysiologists showed excellent initial results at 90 and 180 days for patients with LSPAF. This strategy has the advantage that endocardial ablation is not required in all patients.

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