Convergent Ablation For Persistent Atrial Fibrillation: Single Center Experience
Iosif M. Gulkarov, Brian Wong, Francis Benn, Berhane Worku, Ashwad Afzal, Alexander Ivanov, Gioia Turrito, Bharath Reddy.
New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
OBJECTIVE: Endocardial catheter ablation has been shown to be effective in patients with paroxysmal atrial fibrillation (AF), while the same efficacy has not been demonstrated in patients with persistent AF. Lately, there was a trend toward a hybrid approach in the treatment of persistent AF where epicardial ablation through minimally invasive approach is combined with endocardial catheter ablation. It is believed that this comprehensive approach may offer a more effective treatment for persistent AF.
METHODS: This is a single center retrospective analysis of 25 patients with persistent AF who underwent the convergent procedure between October 2013 and March 2016. Demographics, intraoperative and postoperative outcome data were collected retrospectively. All patients underwent surgical epicardial ablation of the posterior LA through a subxiphoid transdiaphragmatic approach, followed by radiofrequency endocardial ablations on the same day. Patients were followed at three months intervals after a blanking period of three months with static electrocardiograms (n=9), loop recorders (n=6) or implanted pacemaker/defibrillator devices (n=10).
RESULTS: Sinus rhythm (SR) was achieved intraoperatively in all patients. Recurrence was defined according to Heart Rhythm Society definitions. At a median follow-up of 13.5 months (IQR 7.1 to 24.7) 78.3% of patients were in SR at the last follow-up. At 6, 12, 18 and 24 months follow-up 91.3%, 93.3%, 90.9% and 80% of patients were in SR respectively. After blanking period of three months, freedom from AF recurrence at any point up to the last follow-up was 78.3%, 62.5%, 50%, and 40% at 6, 12, 18 and 24 months. Kaplan-Meier event free survival analysis revealed an AF free survival of 91.3%, 83.7%, 74.4% and 49.6% at 6, 12, 18 and 24 months respectively (Figure 1). Three patients (12%) had complications: one suffered a minor cerebrovascular accident with no residual deficit and the other two developed hemopericardium with tamponade physiology that required emergent pericardial drainage.
CONCLUSIONS: Our experience showed the hybrid procedure is a relatively safe and effective option for patients with persistent AF.
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