ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2021
Heart-team hybrid approach to persistent atrial fibrillation with dilated atria: the added value of continuous rhythm monitoring.
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.
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3 citing papers in PubMed, 7 citations in OpenAlex.
- Hybrid atrial fibrillation ablation.Annals of cardiothoracic surgery · 2024Review
- The fate of patients after failed epicardial ablation of atrial fibrillation.Journal of cardiothoracic surgery · 2021Article
- Ablation of persistent atrial fibrillation: the added value of hybrid.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2021Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
15 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess by a continuous implantable rhythm monitoring (ILR) the mid-term outcomes of a staged-hybrid approach for patients with persistent/long-standing persistent atrial fibrillation (AF) and dilated atria.
methodsFifty patients [age 57 (standard deviation, SD: 8.3), previous catheter ablation 66%, AF history 6.5 (2-12) years, left ventricular ejection fraction 56 (SD: 7.9)%, left atrial volume index 44 (38-56) ml/m2] with persistent (44%) or long-standing persistent (56%) AF, underwent a 2-staged hybrid ablation (thoracoscopic epicardial procedure with Cobra-Fusion system and transcatheter Rhythmia mapping with endocardial touch-up of gaps). All patients received an ILR.
resultsNo hospital deaths and no stroke occurred. Follow-up was 98% complete [median 22 (11-34) months]. The 2-year arrhythmia-free survival off class I-III antiarrhythmic drugs/electrical cardioversion/redo catheter ablation and the arrhythmia control (maintenance of sinus rhythm with or without antiarrhythmic drugs/electrical cardioversion) were 65 (SD: 7.1)% and 82 (SD: 5.8)%, respectively. The occurrence of AF in the blanking period was identified as an independent predictor of AF recurrence (odds ratio 26.6, 95% confidence interval 5.3, 132.3; P < 0.001). At longitudinal analysis, the predicted prevalence of sinus rhythm and sinus rhythm off class I-III antiarrhythmic drugs/electrical cardioversion/redo catheter ablation was 82% and 69% at 2 years, respectively. Among patients with recurrence, 50% had short-lasting asymptomatic episodes, identified only by ILR monitoring. The proportion of patients with AF burden ≤1% was 82% and 91% at 1 and 2 years, respectively, and in these cases, left atrial volume index decreased from 46 (SD: 12) ml/m2 to 41 (SD: 11) ml/m2 (P = 0.026).
conclusionsA staged hybrid approach yields promising results in selected patients with persistent/long-standing persistent AF and dilated left atrium who are at very high risk of AF recurrence. The use of ILR in this setting should become a standard to optimize patient management.
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