ArticleJournal of cardiothoracic surgery2026
Long-term outcomes of one-stop unilateral thoracoscopic hybrid ablation for persistent atrial fibrillation after failed catheter ablation.
Article in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHybrid ablation is a treatment option for persistent (PsAF) or long-standing persistent atrial fibrillation (LS-PsAF) after failed catheter ablation (CA), but long-term outcomes (> 5 years) and predictors of recurrence after hybrid ablation in this population have not been well characterized in prior studies.
methodsWe retrospectively analyzed 44 consecutive patients with symptomatic PsAF or LS-PsAF who underwent one-stop unilateral thoracoscopic hybrid ablation with left atrial appendage (LAA) management between May 2015 and April 2021. The procedure consisted of same-day epicardial and endocardial ablation. Primary endpoint was defined as recurrence of atrial arrhythmias ≥ 30 s after the 3-month blanking period, regardless of antiarrhythmic drug (AAD) use. Given the limited sample size and number of events, multivariable Cox regression was performed as an exploratory analysis.
resultsPatients (77.3% male; mean age 59.6 ± 8.3 years) had median AF duration of 8.0 years; 97.7% had prior failed CA (mean 1.4 ± 0.7 procedures). At discharge, 93.2% were in sinus rhythm, with no in-hospital mortality or stroke. Over median 5.2-year follow-up, freedom from arrhythmias at 1, 3, and 5 years was 68.2%, 52.3%, and 50.0%, respectively. Recurrence occurred in 22 patients (50.0%), with 63.6% of recurrences within the first year. On exploratory multivariable Cox regression analysis, left atrial (LA) diameter (HR 1.073, 95% CI: 1.001-1.151, P = 0.047) showed a potential association with recurrence. LAA pathology revealed myocardial hypertrophy (84.1%), inflammation (65.9%), and occult thrombus was identified in 10.0% of LAA specimens (4/40). No thromboembolic events occurred during follow-up.
conclusionsOne-stop hybrid ablation with routine LAA management was associated with acceptable safety and rhythm control in half of patients with PsAF/LS-PsAF at 5 years within this exploratory cohort. These long-term data suggest hybrid ablation is a viable strategy in this challenging population. Although routine LAA resection/clipping yielded promising histological findings, definitive clinical benefits could not be confirmed within this single-arm cohort. Given the exploratory nature of the analysis and limited sample size, these findings require validation in larger prospective multicenter studies.
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