Two-staged hybrid ablation versus thoracoscopic epicardial ablation for long-standing persistent atrial fibrillation: Mid-long term result of a randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yuyuan ¹ , ZENG Rong ¹ , LIU Jian ² , WEI Peijian ² , CHEN Zhao ² , LIU Fangzhou ² , ZHAN Xianzhang ² , XUE Yumei ² ,  GUO Huiming ²

1. Department of Cardiovascular Surgery, Guangdong General Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan, 528251, Guangdong, P.R.China;
2. Atrial Fibrillation Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Cardiovascular Institute, Guangzhou, 510080, P.R.China;

Corresponding author：

GUO Huiming, Email: guohuiming@163.net

Keywords：

Two-staged; hybrid ablation; thoracoscopic epicardial ablation; catheter ablation; long-standing persistent atrial fibrillation

DOI：

10.7507/1007-4848.202011035

Video：

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Objective To evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation.Methods In this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients.Results The mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)].Conclusion We can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.

Citation： ZHANG Yuyuan, ZENG Rong, LIU Jian, WEI Peijian, CHEN Zhao, LIU Fangzhou, ZHAN Xianzhang, XUE Yumei, GUO Huiming. Two-staged hybrid ablation versus thoracoscopic epicardial ablation for long-standing persistent atrial fibrillation: Mid-long term result of a randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(2): 174-181. doi: 10.7507/1007-4848.202011035 Copy

1.	Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 2018, 20(1): e1-e160.
2.	Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) Study. JAMA, 2001, 285(18): 2370-2375.
3.	Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37(38): 2893-2962.
4.	Wendelboe AM, Raskob GE. Global burden of thrombosis: Epidemiologic aspects. Circ Res, 2016, 118(9): 1340-1347.
5.	Andersson T, Magnuson A, Bryngelsson IL, et al. All-cause mortality in 272, 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J, 2013, 34(14): 1061-1067.
6.	Baher A, Marrouche NF. Management of atrial fibrillation in patients with heart failure: time to implement ablation control. Curr Cardiol Rep, 2019, 21(2): 10.
7.	Hwang JK, Jeong DS, Gwag HB, et al. Staged hybrid procedure versus radiofrequency catheter ablation in the treatment of atrial fibrillation. Plos One. 2018;13(10).
8.	Cox JL, Churyla A, Malaisrie SC, et al. A hybrid maze procedure for long-standing persistent atrial fibrillation. Ann Thorac Surg, 2019, 107(2): 610-618.
9.	de Asmundis C, Chierchia GB, Mugnai G, et al. Midterm clinical outcomes of concomitant thoracoscopic epicardial and transcatheter endocardial ablation for persistent and long-standing persistent atrial fibrillation: a single-centre experience. Europace, 2017, 19(1): 58-65.
10.	Maesen B, Pison L, Vroomen M, et al. Three-year follow-up of hybrid ablation for atrial fibrillation. Eur J Cardiothorac Surg, 2018, 53(suppl_1): i26-i32.
11.	Pison L, La Meir M, van Opstal J, et al. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol, 2012, 60(1): 54-61.
12.	Bulava A, Mokracek A, Hanis J, et al. Sequential hybrid procedure for persistent atrial fibrillation. J Am Heart Assoc, 2015, 4(3): e001754.
13.	Krul SP, Pison L, La Meir M, et al. Epicardial and endocardial electrophysiological guided thoracoscopic surgery for atrial fibrillation: a multidisciplinary approach of atrial fibrillation ablation in challenging patients. Int J Cardiol, 2014, 173(2): 229-235.
14.	Kurfirst V, Mokracek A, Bulava A, et al. Two-staged hybrid treatment of persistent atrial fibrillation: short-term single-centre results. Interact Cardiovasc Thorac Surg, 2014, 18(4): 451-456.
15.	Bulava A, Mokracek A, Hanis J, et al. Correlates of arrhythmia recurrence after hybrid epi- and endocardial radiofrequency ablation for persistent atrial fibrillation. Circ Arrhythm Electrophysiol, 2017, 10(8): e005273.
16.	Bulava A, Mokracek A, Eisenberger M, et al. Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system. Cor et Vasa, 2017, 59(4): e359-e366.
17.	Budera P, Osmancik P, Talavera D, et al. Two-staged hybrid ablation of non-paroxysmal atrial fibrillation: clinical outcomes and functional improvements after 1 year. Interact Cardiovasc Thorac Surg, 2018, 26(1): 77-83.
18.	Syed FF, Oral H. Electrophysiological perspectives on hybrid ablation of atrial fibrillation. J Atr Fibrillation, 2015, 8(4): s1290.
19.	Osmancik P, Budera P, Zdarska J, et al. Electrophysiological findings after surgical thoracoscopic atrial fibrillation ablation. Heart Rhythm, 2016, 13(6): 1246-1252.
20.	Budera P, Osmančík P, Talavera D, et al. Eight years experience with thoracoscopic surgical ablation of stand-alone atrial fibrillation in Cardiocenter Kralovske Vinohrady – The evolution of methods and indications and summary of the results. Cor et Vasa, 2015, 57(2): e133-e138.

1. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 2018, 20(1): e1-e160.
2. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) Study. JAMA, 2001, 285(18): 2370-2375.
3. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37(38): 2893-2962.
4. Wendelboe AM, Raskob GE. Global burden of thrombosis: Epidemiologic aspects. Circ Res, 2016, 118(9): 1340-1347.
5. Andersson T, Magnuson A, Bryngelsson IL, et al. All-cause mortality in 272, 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J, 2013, 34(14): 1061-1067.
6. Baher A, Marrouche NF. Management of atrial fibrillation in patients with heart failure: time to implement ablation control. Curr Cardiol Rep, 2019, 21(2): 10.
7. Hwang JK, Jeong DS, Gwag HB, et al. Staged hybrid procedure versus radiofrequency catheter ablation in the treatment of atrial fibrillation. Plos One. 2018;13(10).
8. Cox JL, Churyla A, Malaisrie SC, et al. A hybrid maze procedure for long-standing persistent atrial fibrillation. Ann Thorac Surg, 2019, 107(2): 610-618.
9. de Asmundis C, Chierchia GB, Mugnai G, et al. Midterm clinical outcomes of concomitant thoracoscopic epicardial and transcatheter endocardial ablation for persistent and long-standing persistent atrial fibrillation: a single-centre experience. Europace, 2017, 19(1): 58-65.
10. Maesen B, Pison L, Vroomen M, et al. Three-year follow-up of hybrid ablation for atrial fibrillation. Eur J Cardiothorac Surg, 2018, 53(suppl_1): i26-i32.
11. Pison L, La Meir M, van Opstal J, et al. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol, 2012, 60(1): 54-61.
12. Bulava A, Mokracek A, Hanis J, et al. Sequential hybrid procedure for persistent atrial fibrillation. J Am Heart Assoc, 2015, 4(3): e001754.
13. Krul SP, Pison L, La Meir M, et al. Epicardial and endocardial electrophysiological guided thoracoscopic surgery for atrial fibrillation: a multidisciplinary approach of atrial fibrillation ablation in challenging patients. Int J Cardiol, 2014, 173(2): 229-235.
14. Kurfirst V, Mokracek A, Bulava A, et al. Two-staged hybrid treatment of persistent atrial fibrillation: short-term single-centre results. Interact Cardiovasc Thorac Surg, 2014, 18(4): 451-456.
15. Bulava A, Mokracek A, Hanis J, et al. Correlates of arrhythmia recurrence after hybrid epi- and endocardial radiofrequency ablation for persistent atrial fibrillation. Circ Arrhythm Electrophysiol, 2017, 10(8): e005273.
16. Bulava A, Mokracek A, Eisenberger M, et al. Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system. Cor et Vasa, 2017, 59(4): e359-e366.
17. Budera P, Osmancik P, Talavera D, et al. Two-staged hybrid ablation of non-paroxysmal atrial fibrillation: clinical outcomes and functional improvements after 1 year. Interact Cardiovasc Thorac Surg, 2018, 26(1): 77-83.
18. Syed FF, Oral H. Electrophysiological perspectives on hybrid ablation of atrial fibrillation. J Atr Fibrillation, 2015, 8(4): s1290.
19. Osmancik P, Budera P, Zdarska J, et al. Electrophysiological findings after surgical thoracoscopic atrial fibrillation ablation. Heart Rhythm, 2016, 13(6): 1246-1252.
20. Budera P, Osmančík P, Talavera D, et al. Eight years experience with thoracoscopic surgical ablation of stand-alone atrial fibrillation in Cardiocenter Kralovske Vinohrady – The evolution of methods and indications and summary of the results. Cor et Vasa, 2015, 57(2): e133-e138.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Two-staged hybrid ablation versus thoracoscopic epicardial ablation for long-standing persistent atrial fibrillation: Mid-long term result of a randomized controlled trial

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