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One-staged Versus Two-staged Hybrid Ablation for Long-standing Persistent Atrial Fibrillation: A Propensity-matched Cohort Study
Ju Mei, Zhaolei Jiang.
Xinhua Hospital, School of Medicine, Shanghai Jiaotong Univers, Shanghai, China.

BACKGROUND: Failure of atrial fibrillation (AF) ablation affected the efficacy of long-standing persistent AF (LSPAF). To compare the outcomes of one-staged with two-staged minimally invasive surgical-catheter hybrid ablation for LSPAF.
METHODS: From Dec 2015 to Dec 2021, 104 matched patients (one-staged and two-staged, 1:1) were included in study. One-staged group: both left unilateral thoracoscopic epicardial ablation and catheter ablation were performed simultaneously in one procedure. Two-staged group: Epicardial ablation was performed at the first hospitalization. If patient recurred AF, transcatheter ablation was performed at 3 months to 1 year after epicardial ablation.
RESULTS: Electrophysiological examination showed incomplete ablation lesions and AF termination sites. One-staged: Four patients restored to sinus rhythm (SR) after epicardial ablation, and 41 patients restored to SR during endocardial ablation. 86.5% (45/52) achieved intraprocedural AF termination during one-staged hybrid ablation. Two-staged: All 52 patients underwent staged transcatheter endocardial mapping and ablation because of the presence of AF or atrial tachycardia (AT). Forty-seven (90.4%) patients achieved intraprocedural AF or AT termination during staged endocardial ablation. Freedom from AF or AT at 2 years after hybrid ablation was 82.2 5.4% in one-staged group and 87.8 4.7% in two-staged group (P=0.364). Failure of intraprocedural AF termination [HR: 5.322, P=0.012] was an independent risk factor for AF recurrence after hybrid ablation.
CONCLUSIONS: Both one-staged and two-staged hybrid ablation could be safely and effectively applied to cure LSPAF. Improving the intraprocedural AF termination rate would be extremely important for LSPAF in hybrid ablation, which may predict satisfactory clinical outcomes.Figure legend: hybrid ablation for long-standing persistent atrial fibrillation


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