Hybrid Approach in Patients with Persistent and Long-standing Persistent Atrial Fibrillation: One Year of Follow-up
Zhigalkovich A.S.1, Oleg Pidanov2, Oleg Sapelnikov3, Alexandr Emelianov3, Artem Sveshnikov4, Darin Ardus3, Dmitrii Cherkashin3, Igor Grishin3, Renat Akchurin3
1Republican Scientific and Practical Center "Cardiology", Minsk, Belarus, 2I.V.Davidovsky Moscow City Hospital, Moscow, Russian Federation, 3National Medical Research Center of Cardiology, Moscow, Russian Federation, 4N.I. Pirogov National Medical Surgical Center, Moscow, Russian Federation
BACKGROUND: Hybrid ablation is an effective technology for patients with persistent and long-standing persistent atrial fibrillation. The aim of current study was to evaluate the efficacy and safety of hybrid ablation in patients with persistent and long-standing persistent atrial fibrillation.
METHODS: Fifty-nine patients (59) with persistent and long-standing persistent AF were included. The mean age was 55,5±8,9 years. Mean left atrial volume was 85,5±14,7 ml. First, thoracoscopic epicardial ablation with left atrial appendage closure/resection was performed. Electrophysiological evaluation and catheter ablation were performed in 2-3 months afterwards to verify or complete (if needed) left atrial lesion and ablation of the cavotricuspid isthmus. ECG and 24-h Holter-monitoring were used to evaluate the efficacy after 2 steps in 12 months of follow up.
RESULTS: The Dallas lesion set was successfully performed in 54 patients and box lesion set was made in 5 cases. LAA closure/resection was performed using surgical stapler. Mean time of procedure was 141,3±33,3 min. Conversion to sternotomy was needed in one case. Six (6) patients (10,2%) had atrial flutter. Total efficacy of surgical ablation was 76,3%. In three months of follow-up 14 patients underwent electrophysiological evaluation and catheter ablation. The gaps in left atrial ablation lines were closed in 7 patients; cavotricuspid isthmus ablation was performed in 7 patients. Total efficacy of two stage hybrid ablation was 88,1% in one year of follow up.
CONCLUSIONS: Hybrid ablation is an effective strategy for patients with persistent and long-standing persistent AF. Over 80% of patients had no AF recurrences in one year of follow up. Catheter ablation was needed mostly in patients with atrial flutter.