New Hope For Patients And Challenge For Multidisciplinary Arrhythmia Team - Hybrid Convergent Approach For Atrial Fibrillation Treatment
Michał Zembala1, Piotr Buchta2, Krzysztof Myrda2, Krzysztof Filipiak1, Łukasz Szumowski3, Oskar Kowalski4, Zbigniew Kalarus4, Mariusz Gąsior2, Marian Zembala5.
1Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases,, Zabrze, Poland, 23rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland, 3Department of Heart Rhythm Disorders, Institute of Cardiology, Warszawa, Poland, 4Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland, 5Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases,, Zabrze, Poland,, Zabrze, Poland.
Objective: The most challenging arrhythmic group are patients with persistent medical refractory atrial fibrillation, especially in individuals after ineffective endocardial ablation. The recently published data suggest the important role of left atrial posterior wall and epicardial myocardial layers ablation in rhythm control therapy in this population. However, the endocardial ablation not always is effective in transmural substrate modification. The alternative treatment option is minimally invasive hybrid approach combining the strengths of surgical and catheter ablation. The aim of the study was to assess the periprocedural safety, acute and long- term results of hybrid ablation.Method: We report in prospective analysis a single-center experience of hybrid ablation using minimally invasive transabdominal approach, describing 115 consecutive patients with medical refractory atrial fibrillation ablated between 12.2009 and 2018. The demographic, peri-procedural, in-hospital data as well as 12-month long-term follow-up results were obtained. Results: 115 patients were included, mean age 55 years, 60,9% with persistent AF. The baseline and procedural characteristic are summarized in Table 1. The surgical ablation was related with 2,6% incidence of complications, however without any fatal one. In 67% of patients additional endocardial substrate was modified endocardially. The 12 - month follow-up data were available in 102 patients, 83,4% of them were free of symptomatic arrhythmia episodes. No serious adverse event was observed in the follow-up after discharge.Conclusion: The hybrid, multidisciplinary approach for treatment of AF in safe and in long-term observation very effective treatment method and could be considered as an alternative therapeutic option especially in patients with persistent AF. 
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