Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study.
Heart Rhythm
; 14(11): 1596-1603, 2017 11.
Article
em En
| MEDLINE
| ID: mdl-29101964
ABSTRACT
BACKGROUND:
Catheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort.OBJECTIVE:
To compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF.METHODS:
Fifty-one patients with de novo symptomatic LSPAF were recruited. Twenty-six patients underwent electrophysiologically guided thoracoscopic SA. Conduction block was tested for all lesions intraoperatively by an independent electrophysiologist. In the CA group, 25 consecutive patients underwent stepwise left atrial (LA) ablation. The primary end point was single-procedure freedom from atrial fibrillation (AF) and atrial tachycardia (AT) lasting >30 seconds without antiarrhythmic drugs at 12 months.RESULTS:
Single- and multiprocedure freedom from AF/AT was higher in the SA group than in the CA group 19 of 26 patients (73%) vs 8 of 25 patients (32%) (P = .003) and 20 of 26 patients (77%) vs 15 of 25 patients (60%) (P = .19), respectively. Testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%. In the SA group, complications were experienced by 7 of 26 patients (27%) vs 2 of 25 patients (8%) in the CA group (P = .07).CONCLUSION:
In LSPAF, meticulous electrophysiologically guided thoracoscopic SA as a first-line strategy may provide excellent single-procedure success rates as compared with those of CA, but there is an increased up-front risk of nonfatal complications.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
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Toracoscopia
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Eletrocardiografia Ambulatorial
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Ablação por Cateter
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Técnicas Eletrofisiológicas Cardíacas
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Cirurgia Assistida por Computador
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Frequência Cardíaca
Tipo de estudo:
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Heart Rhythm
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Reino Unido