Hybrid surgical and interventional ablation versus video-assisted thoracoscopic surgical ablation for persistent atrial fibrillation: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Haojie ,  ZHENG Zhe , MENG Ying , GAO Ge , WANG Xiaoqi , FAN Hongguang , LI Linlin , ZHONG Zhaoji

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Persistent atrial fibrillation; thoracoscope; hybrid ablation; efficacy

DOI：

10.7507/1007-4848.201804059

Video：

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Objective To verify whether hybrid surgical and interventional ablation(HA) for the treatment of persistent atrial fibrillation (AF) is superior to video-assisted thoracoscopic surgical radiofrequency ablation (VATS-RA). Methods From September 2010 to December 2017, 79 consecutive patients with persistent AF underwent VATS-RA or HA in Fuwai Hospital. VATS-RA was performed in sixty patients (a stand-alone surgical group, 48 males and 12 females, at average age of 56.0±7.6 years, and HA was performed in nineteen patients (a hybrid group, 14 males and 5 females, at average age of 58.0±7.3 years). Follow-up was completed at 3 months, 6 months, 1 year and annually thereafter. Postoperative sinus rhythm was defined as sinus rhythm recorded in 24-hour or 7-day Holter during follow-up, without exhibited rapid atrial tachyarrhythmia≥30 s including AF, atrial flutter, or atrial tachycardia. Results Seventy-eight patients (98.7%) completed the follow-up. Although the preoperative left atrial diameter (49.1±5.3 mm) in the hybrid group was significantly greater than that in the stand-alone surgical group (41.7±6.2 mm, P<0.001). Overall sinus rhythm maintenance rate in the hybrid group was significantly greater than that in the stand-alone surgical group (94.7% versus 64.4%,P=0.011). And sinus rhythm maintenance rate free from anti-arrhythmic drugs (AADs) and catheter ablation in the hybrid group was significantly greater than that in the stand-alone surgical group (84.2% versus 50.8%, P=0.010). Conclusion HA is superior to VATS-RA in the treatment of persistent AF, but a larger sample size is needed for further validation in prospective randomized studies.

Citation： LI Haojie, ZHENG Zhe, MENG Ying, GAO Ge, WANG Xiaoqi, FAN Hongguang, LI Linlin, ZHONG Zhaoji. Hybrid surgical and interventional ablation versus video-assisted thoracoscopic surgical ablation for persistent atrial fibrillation: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 844-848. doi: 10.7507/1007-4848.201804059 Copy

1.	Bulava A, Mokracek A, Hanis J, et al. Sequential hybrid procedure for persistent atrial fibrillation. J Am Heart Assoc, 2015, 4(3): e001754.
2.	On YK, Park KM, Jeong DS, et al. Electrophysiologic results after thoracoscopic ablation for chronic atrial fibrillation. Ann Thorac Surg, 2015, 100(5): 1595-1603.
3.	Krul SP, Driessen AH, van Boven WJ, et al. Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation. Circ Arrhythm Electrophysiol, 2011, 4(3): 262-270.
4.	Mahapatra S, LaPar DJ, Kamath S, et al. Initial experience of sequential surgical epicardial-catheter endocardial ablation for persistent and long-standing persistent atrial fibrillation with long-term follow-up. Ann Thorac Surg, 2011, 91(6): 1890-1898.
5.	Pison L, La Meir M, van Opstal J, et al. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol, 2012, 60(1): 54-61.
6.	郑哲, 姚焰, 李浩杰, 等. 外科和介入复合治疗难治性心房颤动初步经验. 中国循环杂志, 2017, 32(4): 362-366.
7.	Lin D, Frankel DS, Zado ES, et al. Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation. J Cardiovasc Electrophysiol, 2012, 23(8): 806-813.
8.	Pokushalov E, Romanov A, Artyomenko S, et al. Ganglionated plexi ablation for longstanding persistent atrial fibrillation. Europace, 2010, 12(3): 342-346.
9.	Kottkamp H, Bender R, Berg J. Catheter ablation of atrial fibrillation: how to modify the substrate? J Am Coll Cardiol, 2015, 65(2): 196-206.
10.	Cox JL. The first Maze procedure. J Thorac Cardiovasc Surg, 2011, 141(5): 1093-1097.
11.	Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med, 2015, 372(19): 1812-1822.
12.	Kawaji T, Shizuta S, Morimoto T, et al. Very long-term clinical outcomes after radiofrequency catheter ablation for atrial fibrillation: A large single-center experience. Int J Cardiol, 2017, 249: 204-213.
13.	van Laar C, Kelder J, van Putte BP. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg, 2017, 24(1): 102-111.
14.	Janusauskas V, Puodziukaite L, Maneikiene VV, et al. Long-term results of minimally invasive stand-alone bi-atrial surgical ablation with a bipolar ablation device for persistent and longstanding persistent AF: a single-center case series of 91 patients. J Cardiothorac Surg, 2016, 11: 23.
15.	Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze Ⅲ procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg, 2003, 126(6): 1822-1828.
16.	Stulak JM, Suri RM, Burkhart HM, et al. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze Ⅲ procedure? J Thorac Cardiovasc Surg, 2014, 147(5): 1478-1486.
17.	Pison L, Vroomen M, Crijns HJ. Catheter ablation for persistent atrial fibrillation. N Engl J Med, 2015, 373(9): 877-878.
18.	Watanabe Y, Schill MR, Kazui T, et al. Strategies to improve the efficacy of epicardial linear ablation on the beating heart. Innovations (Phila), 2016, 11(6): 414-419.
19.	Kumar P, Kiser AC, Gehi AK. Hybrid treatment of atrial fibrillation. Prog Cardiovasc Dis, 2015, 58(2): 213-220.

1. Bulava A, Mokracek A, Hanis J, et al. Sequential hybrid procedure for persistent atrial fibrillation. J Am Heart Assoc, 2015, 4(3): e001754.
2. On YK, Park KM, Jeong DS, et al. Electrophysiologic results after thoracoscopic ablation for chronic atrial fibrillation. Ann Thorac Surg, 2015, 100(5): 1595-1603.
3. Krul SP, Driessen AH, van Boven WJ, et al. Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation. Circ Arrhythm Electrophysiol, 2011, 4(3): 262-270.
4. Mahapatra S, LaPar DJ, Kamath S, et al. Initial experience of sequential surgical epicardial-catheter endocardial ablation for persistent and long-standing persistent atrial fibrillation with long-term follow-up. Ann Thorac Surg, 2011, 91(6): 1890-1898.
5. Pison L, La Meir M, van Opstal J, et al. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol, 2012, 60(1): 54-61.
6. 郑哲, 姚焰, 李浩杰, 等. 外科和介入复合治疗难治性心房颤动初步经验. 中国循环杂志, 2017, 32(4): 362-366.
7. Lin D, Frankel DS, Zado ES, et al. Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation. J Cardiovasc Electrophysiol, 2012, 23(8): 806-813.
8. Pokushalov E, Romanov A, Artyomenko S, et al. Ganglionated plexi ablation for longstanding persistent atrial fibrillation. Europace, 2010, 12(3): 342-346.
9. Kottkamp H, Bender R, Berg J. Catheter ablation of atrial fibrillation: how to modify the substrate? J Am Coll Cardiol, 2015, 65(2): 196-206.
10. Cox JL. The first Maze procedure. J Thorac Cardiovasc Surg, 2011, 141(5): 1093-1097.
11. Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med, 2015, 372(19): 1812-1822.
12. Kawaji T, Shizuta S, Morimoto T, et al. Very long-term clinical outcomes after radiofrequency catheter ablation for atrial fibrillation: A large single-center experience. Int J Cardiol, 2017, 249: 204-213.
13. van Laar C, Kelder J, van Putte BP. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg, 2017, 24(1): 102-111.
14. Janusauskas V, Puodziukaite L, Maneikiene VV, et al. Long-term results of minimally invasive stand-alone bi-atrial surgical ablation with a bipolar ablation device for persistent and longstanding persistent AF: a single-center case series of 91 patients. J Cardiothorac Surg, 2016, 11: 23.
15. Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze Ⅲ procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg, 2003, 126(6): 1822-1828.
16. Stulak JM, Suri RM, Burkhart HM, et al. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze Ⅲ procedure? J Thorac Cardiovasc Surg, 2014, 147(5): 1478-1486.
17. Pison L, Vroomen M, Crijns HJ. Catheter ablation for persistent atrial fibrillation. N Engl J Med, 2015, 373(9): 877-878.
18. Watanabe Y, Schill MR, Kazui T, et al. Strategies to improve the efficacy of epicardial linear ablation on the beating heart. Innovations (Phila), 2016, 11(6): 414-419.
19. Kumar P, Kiser AC, Gehi AK. Hybrid treatment of atrial fibrillation. Prog Cardiovasc Dis, 2015, 58(2): 213-220.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Hybrid surgical and interventional ablation versus video-assisted thoracoscopic surgical ablation for persistent atrial fibrillation: A case control study

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