The Efficacy and Safety of Hybrid Ablations for Atrial Fibrillation.
JACC Clin Electrophysiol
; 7(12): 1519-1529, 2021 12.
Article
em En
| MEDLINE
| ID: mdl-34217655
ABSTRACT
OBJECTIVES:
This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations.BACKGROUND:
Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited.METHODS:
Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions.RESULTS:
Fifty-nine patients (age 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60.0% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI 41.3-66.8) at 1 year and 43.8% (95% CI 30.7-57.0) at 2 years.CONCLUSIONS:
The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
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Taquicardia Supraventricular
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Ablação por Cateter
Limite:
Aged
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
JACC Clin Electrophysiol
Ano de publicação:
2021
Tipo de documento:
Article