Author + information
- Arash Aryana,
- Stephen Stark,
- Deep Pujara,
- Genevieve Painter,
- Thomas M. Tadros,
- Subramaniam Krishnan and
- James Longoria
Background: Catheter ablation (CA) of long-standing persistent (LSP) atrial fibrillation (AF) is associated with reduced success rates. This analysis examines the acute/long-term outcomes of a staged hybrid surgical and catheter-based ablation strategy for treatment of LSP AF.
Methods: In this study, all pts underwent a total thoracoscopic Maze (TTM) procedure consisting of bipolar radiofrequency (RF) ablation of all pulmonary veins (PVs), ganglionic plexi, left atrial (LA) roof, and lateral right atrial wall with exclusion of the left atrial appendage. A subsequent CA was also performed in all pts within 6-12 weeks during which all PVs were interrogated. CA using open-irrigated RF was used to target the reconnected PVs along with all other inducible arrhythmia mechanisms.
Results: Altogether, 79 pts with LSP AF (age: 69 ± 9 y, 78% male, BMI: 36 ± 6 kg/m2, CHA2DS2-VASc score: 2.4 ± 1.4, LA volume index: 44 ± 11 ml/m2, failed antiarrhythmic drugs: 2.6 ± 1.0, and prior cardioversions: 2.0 ± 1.3) underwent the staged hybrid ablation. Acute adverse events occurred in 2% with TTM and 2% with CA, with 0 mortality at 3 months. At CA, 38 PVs (12%) were found to be reconnected in 20 pts (25%) including: 14 left superior (18%), 10 left inferior (13%), 5 right superior (6%) and 9 right inferior (11%) PVs. All reconnected PVs (100%) were re-isolated using RF. Moreover, all pts (100%) received cavotricuspid isthmus RF ablation for typical right atrial flutter, whereas 68 pts (86%) received mitral isthmus ablation for LA flutters. During long-term follow-up, 17 pts (21%) required a second CA at 57 ± 51 months and 1 pt (1%) required a second and a third CA at 4 and 6 months post-index CA. Overall, 19 pts (24%) remained on oral anticoagulation and 19 pts (24%) on antiarrhythmic agents. There were no strokes/transient ischemic attacks. Freedom from recurrent AF versus atypical atrial flutter was 95% vs. 79% at 1 year, 93% vs. 69% at 2 years, and 87% vs. 45% at 5 years of follow-up, respectively.
Conclusions: A staged hybrid ablation approach using both TTM and CA appears safe and effective with suitable long-term efficacy for treatment of LSP AF. However, arrhythmia recurrence in the form of recurrent atypical atrial flutters remains prevalent.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1190-097
- 2017 American College of Cardiology Foundation