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Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation


Authors: Martin Pešl 1,2,3;  Tomáš Kulík 1,2;  Tomáš Ostřížek 4;  Vladimír Horváth 4;  Filip Souček 1,2;  Katarína Melajová 1;  Katarína Doležalová 1;  Daniela Žáková 4;  Tomasz Jadczyk 2,5;  František Lehar 1;  Jiří Jež 1,2;  Zdenek Stárek 1,2
Authors‘ workplace: I. interní kardioangiologická klinika, Fakultní nemocnice u sv. Anny v Brně, Lékařská fakulta Masarykovy univerzity, Brno 1;  Mezinárodní centrum klinického výzkumu (ICRC), Fakultní nemocnice u sv. Anny v Brně 2;  Biologický ústav, Lékařská fakulta Masarykovy univerzity, Brno 3;  Centrum kardiovaskulární a transplantační chirurgie (CKTCH), Brno 4
Published in: Vnitř Lék 2022; 68(E-5): 20-26
Category: Original Contributions
doi: https://doi.org/10.36290/vnl.2022.069

Overview

Introduction: Single stage thoracoscopic radiofrequency ablation (RFA) is a treatment method for persistent and long-term persistent atrial fibrillation (AF) offering the possibility for patients otherwise inconsolable by conventional catheter RFA. We present a pilot group of patients after the introduction of the new method at our clinical center.

Patients group: A total of 52 patients aged 61.82 ± 9.7 years underwent single stage hybrid ablation (thoracoscopic isolation of pulmonary veins and box lesion followed by catheter verification of the surgical procedure effectivness) for symptomatic persistent and long-term persistent AF with significantly dilated left atrium 57.9 ± 11.0mm in the period September 2016-March 2019.

Results: The median duration of the procedure was 232 minutes and the median duration of hospitalization was 10 days. At discharge, 52 patients (100%) had sinus rhythm. 48 of 52 patients (92.3%) had a 6-month follow-up. 41 of 48 (85.4%) and 38 of 44 (86.4%) of patients were AF free at 3-month and 6-month follow-up, respectively. Acute complications were: one left atrial perforation resolved successfully by suture and one transient ischaemic attack without permanent sequelae. Late complications involved one massive pulmonary embolization and an atrioesophageal fistula. There was no periprocedural myocardial infarction or stroke with permanent sequelae.

Conclusion: Hybrid thoracoscopic-catheter ablation performed during one procedure is an effective and relatively safe mini-invasive method of treatment for long-term persistent atrial fibrillation.

Keywords:

catheter ablation – persistent atrial fibrillation – thoracoscopic ablation – hybrid single stage ablation


Sources

1. Khurshid S, Choi SH, Weng LC, Wang EY, Trinquart L, Benjamin EJ et al. Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults. Circ Arrhythm Electrophysiol. 2018;11(7):e006273.

2. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014 Feb 25;129(8):837-47.

3. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013 Oct 15;112(8):1142-7.

4. Gosselink AT, Crijns HJ, Van Gelder IC, Hillige H, Wiesfeld AC, Lie KI. Low‑dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA. 1992 Jun 24;267(24):3289-93.

5. Kerin NZ, Faitel K, Kerin IA, Quinones L, Stomel RJ. Efficacy of low‑dose amiodarone in the prevention of paroxysmal atrial fibrillation resistant to type IA antiarrhythmic drugs. Am J Ther. 2000 Aug;7(4):245-50.

6. Valembois L, Audureau E, Takeda A, Jarzebowski W, Belmin J, Lafuente‑Lafuente C. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2019 Sep 4;9:CD005049.

7. Guiraudon GM, Klein GJ, Sharma AD, Yee R. Surgical alternatives for supraventricular tachycardias. Am J Cardiol. 1989 Dec 5;64(20):92 J-96J.

8. Williams JM, Ungerleider RM, Lofland GK, Cox JL. Left atrial isolation: new technique for the treatment of supraventricular arrhythmias. J Thorac Cardiovasc Surg. 1980 Sep;80(3):373-80.

9. Cox JL, Boineau JP, Schuessler RB, Ferguson TB, Cain ME, Lindsay BD et al. Operations for atrial fibrillation. Clin Cardiol. 1991 Oct;14(10):827-34.

10. Ad N, Henry L, Hunt S, Barnett S, Stone L. The Cox‑Maze III procedure success rate: comparison by electrocardiogram, 24-hour holter monitoring and long‑term monitoring. Ann Thorac Surg. 2009 Jul;88(1):101-5.

11. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol. 2018 01;20(1):157-208.

12. Nath S, DiMarco JP, Haines DE. Basic aspects of radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 1994 Oct;5(10):863-76.

13. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow‑up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol. 2012 Mar 1;33(2):171-257.

14. Jones DG, Haldar SK, Hussain W, Sharma R, Francis DP, Rahman‑Haley SL et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013 May 7;61(18):1894-903.

15. Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010 Jan 27;303(4):333-40.

16. Haldar S, Jarman JWE, Panikker S, Jones DG, Salukhe T, Gupta D et al. Contact force sensing technology identifies sites of inadequate contact and reduces acute pulmonary vein reconnection: a prospective case control study. Int J Cardiol. 2013 Sep 30;168(2):1160-6.

17. Lehar F, Starek Z, Jez J, Novak M, Wolf J, Stepanova R et al. Comparison of clinical outcomes and safety of catheter ablation for atrial fibrillation supported by data from CT scan or three‑dimensional rotational angiogram of left atrium and pulmonary veins. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov. 2015 Dec;159(4):622-8.

18. Lin T, Ouyang F, Kuck KH, Tilz R. THERMOCOOL® SMARTTOUCH® CATHETER – The Evidence So Far for Contact Force Technology and the Role of VISITAGTM MODULE. Arrhythmia Electrophysiol Rev. 2014 květen;3(1):44-7.

19. Starek Z, Lehar F, Jez J, Scurek M, Wolf J, Kulik T et al. Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation. Indian Heart J. 2018 Feb;70(1):37-44.

20. Wolf J, Starek Z, Jez J, Lehar F, Lukasova M, Kulik T et al. Rotational angiography of left ventricle to guide ventricular tachycardia ablation. Int J Cardiovasc Imaging. 2015 Jun;31(5):899-904.

21. Jadczyk T, Wolf J, Pesl M, Soucek F, Lehar F, Jez J et al. Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation. Diagn Basel Switz. 2022 Mar 1;12(3):612.

22. Nölker G, Heintze J, Gutleben KJ, Muntean B, Pütz V, Yalda A et al. Cryoballoon Pulmonary Vein Isolation Supported by Intracardiac Echocardiography: Integration of a Nonfluoroscopic Imaging Technique in Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol. 2010;21(12):1325-30.

23. Weber H, Sagerer‑Gerhardt M, Heinze A. Laser catheter ablation of long- lasting persistent atrial fibrillation: Longterm results. J Atr Fibrillation. 2017 Aug 31;10(2):1588.

24. Reddy VY, Koruth J, Jais P, Petru J, Timko F, Skalsky I et al. Ablation of Atrial Fibrillation With Pulsed Electric Fields: An Ultra‑Rapid, Tissue‑Selective Modality for Cardiac Ablation. JACC Clin Electrophysiol. 2018 Aug;4(8):987-95.

25. Wojtaszczyk A, Caluori G, Pešl M, Melajova K, Stárek Z. Irreversible electroporation ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2018 Apr;29(4):643-51.

26. Loh P, van Es R, Groen MHA, Neven K, Kassenberg W, Wittkampf FHM et al. Pulmonary Vein Isolation With Single Pulse Irreversible Electroporation: A First in Human Study in 10 Patients With Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2020 Oct;13(10):e008192.

27. Kawamura I, Neuzil P, Shivamurthy P, Kuroki K, Lam J, Musikantow D et al. How does the level of pulmonary venous isolation compare between pulsed field ablation and thermal energy ablation (radiofrequency, cryo, or laser)? Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol. 2021 Nov 8;23(11):1757-66.

28. Hummel J, Michaud G, Hoyt R, DeLurgio D, Rasekh A, Kusumoto F et al. Phased RF ablation in persistent atrial fibrillation. Heart Rhythm. 2014 Feb 1;11(2):202-9.

29. Mont L, Bisbal F, Hernández‑Madrid A, Pérez‑Castellano N, Viñolas X, Arenal A et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014 Feb;35(8):501-7.

30. Verma A, Jiang C yang, Betts TR, Chen J, Deisenhofer I, Mantovan R et al. Approaches to Catheter Ablation for Persistent Atrial Fibrillation. N Engl J Med. 2015 May 7;372(19):1812-22.

31. Scott PA, Silberbauer J, Murgatroyd FD. The impact of adjunctive complex fractionated atrial electrogram ablation and linear lesions on outcomes in persistent atrial fibrillation: a meta‑analysis. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol. 2016 Mar;18(3):359-67.

32. Jez J, Jadczyk T, Lehar F, Pesl M, Kulik T, Belaskova S et al. Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact‑force control. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov. 2019 Oct 10;

33. Calkins H, Reynolds MR, Spector P, Sondhi M, Xu Y, Martin A et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta‑analyses. Circ Arrhythm Electrophysiol. 2009 Aug;2(4):349-61.

34. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010 Feb;3(1):32-8.

35. DeSimone CV, Madhavan E, Ebrille S, Rabinstein AA, Friedman PA, Asirvatham SJ. Atrial Fibrillation and Stroke – Increasing Stroke Risk With Intervention. J Atr Fibrillation. 2013 Dec;6(4):966.

36. Gaita F, Leclercq JF, Schumacher B, Scaglione M, Toso E, Halimi F et al. Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon. J Cardiovasc Electrophysiol. 2011 Sep;22(9):961-8.

37. Gehi AK, Mounsey JP, Pursell I, Landers M, Boyce K, Chung EH et al. Hybrid epicardial‑endocardial ablation using a pericardioscopic technique for the treatment of atrial fibrillation. Heart Rhythm. 2013 Jan;10(1):22-8.

38. Mahapatra S, LaPar DJ, Kamath S, Payne J, Bilchick KC, Mangrum JM et al. Initial experience of sequential surgical epicardial‑catheter endocardial ablation for persistent and long‑standing persistent atrial fibrillation with long‑term follow‑up. Ann Thorac Surg. 2011 Jun;91(6):1890-8.

39. Muneretto C, Bisleri G, Rosati F, Krakor R, Giroletti L, Di Bacco L et al. European prospective multicentre study of hybrid thoracoscopic and transcatheter ablation of persistent atrial fibrillation: the HISTORIC‑AF trial. Eur J Cardio‑Thorac Surg Off J Eur Assoc Cardio‑Thorac Surg. 2017 Oct 1;52(4):740-5.

40. Pison L, Gelsomino S, Lucà F, Parise O, Maessen JG, Crijns HJGM et al. Effectiveness and safety of simultaneous hybrid thoracoscopic and endocardial catheter ablation of lone atrial fibrillation. Ann Cardiothorac Surg. 2014 Jan;3(1):38-44.

41. Toplisek J, Pernat A, Ruzic N, Robic B, Sinkovec M, Cvijic M et al. Improvement of Atrial and Ventricular Remodeling with Low Atrial Fibrillation Burden after Hybrid Ablation of Persistent Atrial Fibrillation. Pacing Clin Electrophysiol PACE. 2016 Mar;39(3):216-24.

42. Kurfirst V, Mokraček A, Bulava A, Čanadyova J, Haniš J, Pešl L. Two‑staged hybrid treatment of persistent atrial fibrillation: short‑term single‑centre results. Interact Cardiovasc Thorac Surg. 2014 Apr;18(4):451-6.

43. Phan K, Pison L, Wang N, Kanagaratnam A, Yan TD, Maesen B et al. Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non‑obese patients. J Thorac, DiS. 2017 z;9(9):3087-3096-3096.

44. Richardson TD, Shoemaker MB, Whalen SP, Hoff SJ, Ellis CR. Staged versus Simultaneous Thoracoscopic Hybrid Ablation for Persistent Atrial Fibrillation Does Not Affect Time to Recurrence of Atrial Arrhythmia. J Cardiovasc Electrophysiol. 2016 Apr;27(4):428-34.

45. Vroomen M, Pison L. Hybrid ablation for atrial fibrillation: a systematic review. J Interv Card Electrophysiol. 2016 Dec 1;47(3):265-74.

46. Jiang YQ, Tian Y, Zeng LJ, He SN, Zheng ZT, Shi L, et al. The safety and efficacy of hybrid ablation for the treatment of atrial fibrillation: A meta‑analysis. PloS One. 2018;13(1):e0190170.

47. Pojar M, Haman L, Parizek P, Myjavec A, Gofus J, Vojacek J. Midterm outcomes of mini‑invasive surgical and hybrid ablation of atrial fibrillation. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov. 2019 Sep;163(3):233-40.

48. Osmancik P, Budera P, Talavera D, Herman D, Vesela J, Prochazkova R et al. Improvement in the quality of life of patients with persistent or long‑standing persistent atrial fibrillation after hybrid ablation. J Interv Card Electrophysiol. 2020 Apr 1;57(3):435-42.

49. Maesen B, Pison L, Vroomen M, Luermans JG, Vernooy K, Maessen JG et al. Three‑year follow‑up of hybrid ablation for atrial fibrillation. Eur J Cardiothorac Surg. 2018 Apr 1;53(suppl_1):i26-32.

50. Buber J, Luria D, Sternik L, Raanani E, Feinberg MS, Goldenberg I et al. Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol. 2011 Oct 4;58(15):1614-21.

51. Di Biase L, Burkhardt JD, Mohanty P, Sanchez J, Mohanty S, Horton R et al. Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation. 2010 Jul 13;122(2):109-18.

52. Santangeli P, Zado ES, Hutchinson MD, Riley MP, Lin D, Frankel DS et al. Prevalence and distribution of focal triggers in persistent and long‑standing persistent atrial fibrillation. Heart Rhythm. 2016 Feb;13(2):374-82.

53. Chovančík J, Bulková V, Fiala M, Gandalovičová J, Královec S, Neuwirth R et al. [A comparison of two methods of long‑term external ECG telemonitoring in patients after ablation for atrial fibrillation]. Vnitr Lek. 2012 Sep;58(9):633-9.

54. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962.

55. G H, T P, N D, E A, Jj B, C BL et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‑Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J [Internet]. 2021 Jan 2 [cited 2021 Dec 9];42(5). Available from: https://pubmed.ncbi.nlm.nih.gov/32860505/

56. Zembala M, Filipiak K, Kowalski O, Boidol J, Sokal A, Lenarczyk R et al. Minimally invasive hybrid ablation procedure for the treatment of persistent atrial fibrillation: one year results. Kardiol Pol. 2012;70(8):819-28.

57. Gersak B, Pernat A, Robic B, Sinkovec M. Low rate of atrial fibrillation recurrence verified by implantable loop recorder monitoring following a convergent epicardial and endocardial ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2012 Oct;23(10):1059-66.

58. Bisleri G, Rosati F, Bontempi L, Curnis A, Muneretto C. Hybrid approach for the treatment of long‑standing persistent atrial fibrillation: electrophysiological findings and clinical results. Eur J Cardio‑Thorac Surg Off J Eur Assoc Cardio‑Thorac Surg. 2013 Nov;44(5):919-23.

59. Zembala M, Filipiak K, Kowalski O, Buchta P, Niklewski T, Nadziakiewicz P et al. Staged hybrid  ablation for persistent and longstanding persistent atrial fibrillation effectively restores sinus rhythm in long‑term observation. Arch Med Sci AMS. 2017 Feb 1;13(1):109-17.

60. Krul SPJ, Driessen AHG, van Boven WJ, Linnenbank AC, Geuzebroek GSC, Jackman WM et al. Thoracoscopic video‑assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical‑electrophysiological approach for atrial fibrillation. Circ Arrhythm Electrophysiol. 2011 Jun;4(3):262-70.

61. Tilz RR, Rillig A, Thum AM, Arya A, Wohlmuth P, Metzner A et al. Catheter Ablation of Long‑Standing Persistent Atrial Fibrillation: 5-Year Outcomes of the Hamburg Sequential Ablation Strategy. J Am Coll Cardiol. 2012 Nov 6;60(19):1921-9.

62. Al‑Jazairi MIH, Rienstra M, Klinkenberg TJ, Mariani MA, Van Gelder IC, Blaauw Y. Hybrid atrial fibrillation ablation in patients with persistent atrial fibrillation or failed catheter ablation. Neth Heart J Mon J Neth Soc Cardiol Neth Heart Found. 2019 Mar;27(3):142-51.

63. Boersma LVA, Castella M, van Boven W, Berruezo A, Yilmaz A, Nadal M et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012 Jan 3;125(1):23-30.

64. Kuck KH, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KRJ et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45.

65. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019 02;321(13):1261-74.

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