Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation
David C. Kress, Lynn M. Erickson, Firas Zahwe, Tadele W. Mengesha, David P. Krum, Jasbir Sra.
Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI, USA.
Objective: It is widely accepted that atrial fibrillation (AF) accounts for a majority of arrhythmia recurrences in endocardial catheter AF ablation. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.
Methods: Patients with persistent AF received both endocardial and epicardial ablation of the posterior left atrial wall using a small midline approach (hybrid). Presence of atrial flutter (AFL) or AF was determined with ambulatory monitoring or electrocardiogram analysis at each follow-up. Recurrence mode was confirmed by electrophysiology study (EPS) for those with another ablation after hybrid ablation.
Results: Patients were followed for a mean (ąSD) of 25 (14) months, and antiarrhythmic drug use at follow-up was 51%. Of patients who had a recurrence, 53% (n=33) were in AFL and 47% (n=29) were in AF. Of those who had a recurrence with AFL, 14 patients received repeat ablation for either left (n=12) or left/right (n=2) AFL (Table).
Conclusions: AFL accounts for about half of hybrid recurrences. Half of ablations for AFL recurrence following the hybrid procedure involved the mitral isthmus. This region should be considered in catheter ablation during the hybrid procedure to prevent the perimitral flutter incidence seen in our center in subsequent ablation procedures.
| AFL ablation location (n=14) | Frequency, n (%) |
| Perimitral | 4 (29) |
| Left atrial roof | 3 (22) |
| Perimitral and right atrium | 2 (14) |
| Perimitral and left atrial roof | 1 (7) |
| Left superior pulmonary vein and left atrial appendage | 1 (7) |
| Posterior wall | 1 (7) |
| Multiple left | 2 (14) |
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