A heart-team hybrid approach for atrial fibrillation: a single-centre long-term clinical outcome cohort study. (13th July 2021)

• Record Type: Journal Article
• Authors: Dunnington, Gansevoort H; Pierce, Carrie L; Eisenberg, Susan; Bing, Liem L; Chang-Sing, Peter; Kaiser, Daniel W; Burk, Shelby; Moulton, Linda C; Kiankhooy, Armin
• Is Part Of: European journal of cardio-thoracic surgery. Volume 60:Number 6(2021)
• Page Start: 1343
• Page End: 1350
• Publication Date: 2021-07-13
• Subjects: Atrial fibrillation -- Arrhythmia surgery -- Hybrid ablation -- Maze surgery; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab197
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: The Cox-maze IV is the gold standard for surgical ablation of atrial fibrillation (AF). A heart-team hybrid approach using selected epicardial thoracoscopic surgical ablations and completion endocardial ablations to replicate the Cox-maze IV lesion set has gained popularity and early results have been promising. We herein report our single-centre long-term clinical outcomes using the heart-team hybrid approach with 455 patients. METHODS: From 1 March 2013 to 1 July 2019, we prospectively collected data on all patients referred to our heart team for rhythm-control strategy for AF. Baseline characteristics, procedural complications and long-term freedom from AF (FFAF) both on and off anti-arrhythmic drug therapy were analysed. Ambulatory monitoring (>7 days) was obtained at 3 months and annually thereafter. RESULTS: Four hundred and fifty-five patients completed the hybrid approach. Four hundred and forty-five (97.8%) patients had non-paroxysmal AF (long-standing persistent AF n = 249, 54.7%; persistent AF n = 196, 43.1%; paroxysmal AF n = 10, 2.2%). Average duration of AF was 5.9 ± 6.1 years. Average left atrial diameter was 4.8 ± 0.8 cm. FFAF at 3, 12, 24 and 36 months was 92%, 87%, 81% and 72%, respectively. FFAF without the use of anti-arrhythmic medications was 75%, 81%, 76% and 66%. Any surgical complications occurred in 28 (6.1%) patients. CONCLUSIONS: A heart-team hybrid strategy for the treatment of AF is safe and effective. In a predominantly non-paroxysmal population with AF, at the 3-year follow-up, FFAF in patients on and off anti-arrhythmic drugs approaches that of patients who had the Cox-maze IV. Abstract : Atrial fibrillation (AF) remains the most common cardiac arrhythmia [1] and its treatment continues to evolve.