Convergent ablation for persistent atrial fibrillation: outcomes from a single-centre real-world experience.
Arrhythmias
Atrial fibrillation
Catheter ablation
Hybrid ablation
Persistent atrial fibrillation
Journal
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
ISSN: 1873-734X
Titre abrégé: Eur J Cardiothorac Surg
Pays: Germany
ID NLM: 8804069
Informations de publication
Date de publication:
02 12 2022
02 12 2022
Historique:
received:
15
04
2022
revised:
09
10
2022
pubmed:
9
11
2022
medline:
20
12
2022
entrez:
8
11
2022
Statut:
ppublish
Résumé
Atrial fibrillation (AF) is common and can cause significant morbidity and detriment to quality of life. Success rates for conventional catheter ablation are suboptimal in persistent AF (PsAF), especially when longstanding. Convergent hybrid ablation combines endoscopic surgical epicardial and endocardial catheter ablation. It offers promise in treating PsAF. We aimed to evaluate outcomes at our centre following convergent ablation. We conducted an observational study of patients undergoing ablation from 2012 to 2019 at a London cardiac centre. Sixty-seven patients underwent convergent ablation entailing epicardial ablation, mostly via sub-xiphoid access, followed by endocardial left atrial catheter ablation. Baseline and follow-up data were obtained retrospectively from clinical records. Primary outcome was freedom from AF on/off anti-arrhythmic drugs after 12-month follow-up. Secondary outcomes included freedom from AF over the entire follow-up, freedom from anti-arrhythmic drugs, freedom from atrial arrhythmias, symptom status, repeat ablation and complications. At baseline, 80.6% had PsAF >1 year (80.6%), 49.3% had body mass index >30 kg/m2 at baseline and 19.4% had left ventricular ejection fraction of 40% or less. The median follow-up was 2.3 (1.4-3.7) years. Freedom from AF recurrence was 81.3% at 1 year and 61.5% over overall follow-up. Eleven patients (16.4%) required redo AF ablation. Prolonged AF duration was associated with increased recurrence at 12 months and duration >5 years with a shorter time to recurrence on Kaplan-Meier analysis, but this and other factors did not significantly impact the AF recurrence during the overall follow-up period. Convergent ablation had good 1-year and overall success rates for treating PsAF. Our results in a diverse, real-world population support the potential of convergent ablation in patients with challenging to treat PsAF.
Identifiants
pubmed: 36346176
pii: 6809126
doi: 10.1093/ejcts/ezac515
pmc: PMC9748999
pii:
doi:
Substances chimiques
Anti-Arrhythmia Agents
0
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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