Author + information
- Fang-Zhou Liu,
- Hui-Ming Guo,
- Yu-Mei Xue,
- Xian-Zhang Zhan,
- Hong-Tao Liao,
- Jian Liu and
- Shu-Lin Wu
Long-standing persistent atrial fibrillation (LSPAF) is the most challenging AF type, either via surgery or catheter. This study aimed to assess the success rate among epicardial thoracoscopic ablation (epi-TSA), endocardial catheter ablation (endo-CA) and sequential hybrid procedure.
Patients with LSPAF were included and prospectively followed. Endo-CA was carried out via percutaneous approach, epi-TSA via thoracoscopic approach. Sequential hybrid procedure posterior to epi-TSA was done 3 months later (to consummate epi-TSA ablation set and block cavotricuspid isthmus).
Sixty-four LSPAF patients underwent epi-TSA, 16 of those underwent sequential hybrid procedure. Ninety-five LSPAF patients underwent endo-CA. During the sequential hybrid procedure, there were 5(31.3%) patients with all pulmonary veins (PVs) isolation, 11(68.8%) with left PV isolation, 4(25%) with roof-line block and only 2(12.5%) with box lesion. A total of 57 gaps were identified in 14 patients, which were mainly on roof-line and anterior mid-superior right PV. After mean follow-up of 11.8±7.7 months, 34(70.8%) patients in epi-TSA alone group, 14(87.5%) in sequential hybrid group and 52(54.7%) in endo-CA group were free of atrial arrhythmias(P<0.01). In epi-TSA group, 1 patient was changed to open-chest Cox-MAZE IV due to atrium roof perforation. In endo-CA alone group, cardiac tamponade and drainage was performed in 1 patient.
Sequential hybrid procedural can improve maintenance of sinus rhythm compared to endo-CA or epi-TSA alone in LSPAF patients. Conduction-gaps are mainly on roof-line and anterior mid-superior right PV.