Midterm outcomes of two-staged hybrid ablation of persistent and long-standing persistent atrial fibrillation using the versapolar epicardial surgical device and subsequent catheter ablation

2017 ◽  
Vol 50 (2) ◽  
pp. 187-194 ◽  
Author(s):  
Petr Budera ◽  
Pavel Osmancik ◽  
Dalibor Herman ◽  
Jana Zdarska ◽  
David Talavera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Surgical Device ◽  
Hybrid Ablation

Facilitated Coupling of Magnetic Introducers During Thoracoscopic Ablation of Atrial Fibrillation

2019 ◽  
Vol 14 (5) ◽  
pp. 480-482
Author(s):  
Syed M. Ali Hassan ◽  
Benedict Glover ◽  
Andres Enriquez ◽  
Gianluigi Bisleri
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Epicardial Ablation ◽  
Ablation Procedure ◽  
Linear Ablation ◽  
Surgical Device ◽  
Hybrid Ablation

A 51-year-old man with long-standing persistent atrial fibrillation underwent a hybrid ablation procedure with right thoracoscopic epicardial ablation. Fluoroscopy was utilized in a novel way to visualize the magnetic tip catheters of the linear ablation surgical device and allow easier coupling of the tips, making this procedure more efficient and reducing the risk of improper positioning of the ablation device.

scholarly journals Comparative Effectiveness of Hybrid Ablation Versus Endocardial Catheter Ablation Alone in Patients With Persistent Atrial Fibrillation

2017 ◽  
Vol 3 (4) ◽  
pp. 341-349 ◽  
Author(s):  
David C. Kress ◽  
Lynn Erickson ◽  
Indrajit Choudhuri ◽  
Jodi Zilinski ◽  
Tadele Mengesha ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Comparative Effectiveness ◽  
Persistent Atrial Fibrillation ◽  
Hybrid Ablation

Abstract 16499: Hybrid Cryoballoon Pulmonary Vein Isolation and Radiofrequency Posterior Wall Isolation for Persistent Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heajung L Nguyen ◽  
Carlos Macias ◽  
Houman Khakpour ◽  
Jason S Bradfield ◽  
Kalyanam Shivkumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Energy Source ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Significant Difference ◽  
Hybrid Ablation

Introduction: Catheter ablation of persistent atrial fibrillation (AF) is associated with less successful outcomes compared to paroxysmal AF. The optimal ablation strategy for persistent AF is not well established. We report our center’s experience utilizing a hybrid ablation approach of cryoballoon (CB) pulmonary vein isolation (PVI) followed by radiofrequency (RF) left atrial posterior wall isolation (LAPWI). Methods: 134 patients with persistent AF who underwent catheter ablation between 2016 and 2019 at our center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Hybrid ablation (n=62) consisted of CB PVI followed by RF roof and floor lines resulting in LAPWI. The control group (n=72) had PVI ±LAPWI with either CB (n=38) or RF (n=34). Outcomes were monitored with office visits and 7-day Holter monitors at 3, 6, 12, and 24 months post-ablation. The primary endpoint was freedom from any documented atrial tachyarrhythmia over 30 seconds. Results: Concomitant atrial flutter ablation was performed in 19/62 (31%) and 5/72 (7%) of hybrid and control cases, respectively. There was no significant difference in procedure time, however fluoroscopy time was shorter with hybrid ablation compared to control (p<.01). 18-month freedom from atrial tachyarrhythmias was 70.4% with hybrid ablation and 51.6% with PVI±LAPWI with a single energy source (p=.048). Among those with recurrence, mean AF burden was significantly lower with hybrid ablation (7%) than with a single-energy approach (60%). Conclusion: In this single center experience with multiple operators, hybrid CB-RF PVI and LAPWI reduced AF recurrence (incidence and burden) compared to PVI±LAPWI with a single energy source.

Hybrid versus catheter ablation in patients with persistent and longstanding persistent atrial fibrillation: a systematic review and meta-analysis†

2019 ◽  
Vol 56 (3) ◽  
pp. 433-443 ◽  
Author(s):  
Claudia A J van der Heijden ◽  
Mindy Vroomen ◽  
Justin G Luermans ◽  
Rein Vos ◽  
Harry J G M Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Meta Analysis ◽  
Persistent Atrial Fibrillation ◽  
Pubmed Database ◽  
Study Heterogeneity ◽  
Baseline Characteristics ◽  
Hybrid Ablation ◽  
Standard Strategy

Summary As the mechanisms underlying persistent atrial fibrillation (AF) are still incompletely understood, a ‘gold standard’ strategy for ablation is lacking. The results of catheter ablation, independent of the ablation strategy applied, are disappointing. Hybrid ablation, combining a thoracoscopic epicardial and transvenous endocardial approach, has shown more favourable outcomes. To date, studies comparing both techniques are lacking. Therefore, we conducted a systematic review and meta-analysis of hybrid versus catheter ablation in patients with persistent or longstanding persistent AF. A systematic literature search of studies reporting on catheter and hybrid ablation of persistent or longstanding persistent AF was performed in the PubMed database. All identified articles were screened and checked for eligibility. A meta-analysis was performed on inter-study heterogeneity and pooled correlation between baseline characteristics, primary and secondary outcomes of hybrid and catheter studies. From the 520 articles identified by the search, 34 articles could be included in the analysis. Hybrid ablation resulted in higher freedom of atrial arrhythmias in patients with persistent and longstanding-persistent AF than catheter ablation (70.7% vs 49.9%, P < 0.001). Although hybrid ablation had a slightly higher complication rate than catheter ablation, overall morbidity and mortality were low. In conclusion, hybrid ablation is more effective than catheter ablation in maintaining the sinus rhythm in patients with persistent or longstanding persistent AF. However, data directly comparing both techniques are lacking, and small, heterogenic, single-arm studies in a random-effects model prevent definite conclusions from being drawn. Therefore, larger randomized controlled trials directly comparing both techniques are needed.

scholarly journals Intraprocedural arrhythmia termination as an end point for hybrid ablation in patients with long-standing persistent atrial fibrillation: a 2-year follow-up study

2021 ◽  
Author(s):  
Chen Tan ◽  
Li-Jun Zeng ◽  
Hai-Feng Shi ◽  
Ying Tian ◽  
Nan Ma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Cox Regression ◽  
Persistent Atrial Fibrillation ◽  
Surgical Ablation ◽  
Thoracoscopic Approach ◽  
End Point ◽  
Hybrid Ablation

Abstract OBJECTIVES Hybrid catheter and surgical ablation has emerged as an effective therapy for patients with persistent atrial fibrillation (AF). The aims of this study were to evaluate the relationship between intraprocedural arrhythmia termination and the long-term outcomes of hybrid ablation in patients with long-standing persistent AF. METHODS From May 2015 through April 2019, 50 patients with persistent AF with a mean duration of 73.3 ± 62.1 (median 54) months underwent single-step hybrid ablation. Pulmonary vein isolation, left atrial posterior wall isolation and left atrial appendage excision or closure were performed through a left-sided thoracoscopic approach. Subsequently, all patients underwent high-density endocardial mapping and electrogram-based ablation with the end point of AF termination. RESULTS We achieved intraprocedural AF termination in 84% (42/50) patients; this end point was reached in 16 patients during surgical ablation and in 26 patients during catheter ablation. Seven patients underwent repeat catheter ablation. After a mean follow-up period of 29 ± 13 months, the freedom from atrial tachyarrhythmia of a single procedure without the use of antiarrhythmic drugs was 70% (35/50). In the Cox regression model, intraprocedural termination of AF (hazard ratio 0.205, 95% confidence interval 0.058–0.730; P = 0.014) was the sole predictor of success. CONCLUSIONS The 2-year outcomes of a one-stop hybrid ablation with an end point of AF termination are promising in patients with long-standing persistent AF.

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