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Outcomes Of One-stage Hybrid Ablation With Modified Bi-atrial Lesion Set For Intractable Atrial Fibrillation: A Pilot Study
Haojie Li, Lihui Zheng, Hengqiang Lin, Yin Meng, Sheng Liu, Chenfei Rao, Xiaoyi Wang, Yan Yao, Zhe Zheng
Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Objectives: Enlarged left atrium and longer duration of atrial fibrillation (AF) are the risk factors of postoperative recurrence of AF in surgical or interventional ablation. We aimed to evaluate the efficacy of one-stage hybrid ablation with modified bi-atrial lesion in these patients.
Methods: We prospectively enrolled patients with long-standing persistent AF and left atrial diameter greater than 50mm and underwent one-stage hybrid thoracoscopic surgical and catheter ablation between December 2016 and December 2018 at our center. We applied a modified bi-atrial lesion set for the surgical epicardial ablation. Then, we completed catheter ablation along the epicardial ablation lines with normal or low voltage on endocardial mapping check (Figure 1). We followed up all patients at 3, 6, 12 months and annually thereafter after the procedure. Postoperative restoration of sinus rhythm was evaluated by 24-hour or 7-day Holter. Any patient with equal to or greater than 30s at AF, atrial flutter, or atrial tachycardia during follow-up was considered as failure.
Results: Twenty-five patients (19 males, mean age 58.8 ± 6.6 years) were enrolled. The mean AF lasting duration was 4.5±3.9 years. Left atrial diameter was 54.2±4.3mm. After epicardial ablation, left atrial endocardial mapping check was completed in twenty-five patients, and showed that the entrance and exit block of left and right pulmonary vein was successfully achieved in 24 (96%) and 25 (100%) patients, respectively. Normal voltage was displayed in 24%,32%,48%,44% patients on the roof line, bottom line, mitral isthmus line and left fibrous trigone line at left atrium on endocardial mapping, and mean ratio of normal voltage was 33.8%, 18.4% ,41.4%,20.9% in these ablation lines, respectively. The median follow-up time was 12 months Recurrent AF and postoperative atrial flutter were present in two and seven patients respectively. Four patients with postoperative atrial flutter underwent secondary catheter ablation and restored sinus rhythm. The overall success rate with and without antiarrhythmic drugs or secondary catheter ablation was 80% and 64%.
Conclusions: One-stage hybrid ablation with modified bi-atrial lesion can acquire encouraging results in the treatment of intractable atrial fibrillation. Postoperative atrial flutter was the major type of recurrent atrial tachycardic arrhythmia.


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