Document Detail


Hybrid Procedure (Endo/Epicardial) Versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center.
MedLine Citation:
PMID:  24252286     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Ablation of long-standing persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach.
OBJECTIVE: We investigated the difference in success and complication rates between a combined surgical epicardial and endocardial catheter ablation procedure and our standard extensive endocardial catheter ablation procedure.
METHODS: 24 consecutive pts (group 1) with LSPAF and enlarged left atrium (antero-posterior diameter >5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, unipolar radio-frequency ablation (nContact, NC, USA) via pericardial access, and concomitant extensive endocardial ablation. Procedural complications and long-term (24 months) outcomes were compared to those of 35 consecutive pts who refused the hybrid procedure and underwent standard endocardial ablation (Group 2).
RESULTS: Baseline characteristics were comparable. In group 1, one patient (4.2%) developed post-procedural cardio-embolic stroke and 3 (12.5%) died (one suffered atrio-esophageal fistula, one fatal stroke, one of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for the combined ablation group (p=0.036). At 24-month follow-up, 4 (16.7%) patients in group 1 and 19 (54.3%) pts in group 2 were arrhythmia-free after a single procedure, either on or off anti-arrhythmic drugs (log-rank test p=0.002). Total procedural time and hospitalization length were significantly shorter for the endocardial procedure (P <0.001), while RF time and fluoroscopic time were not statistically different (p >0.05).
CONCLUSION: In pts with LSPAF and enlarged atrium, a concomitant combined unipolar surgical/endocardial ablation approach increases complication rate and does not improve outcomes when compared to extensive endocardial ablation only.
Authors:
Zachary Edgerton; Alessandro Paoletti Perini; Prasant Mohanty; Chintan Trivedi; Rong Bai; Pasquale Santangeli; Sanghamitra Mohanty; Rodney Horton; J David Burkhardt; G Joseph Gallinghouse; Javier E Sanchez; Shane Bailey; Jason D Zagrodzky; Lane Maegen; Andrew Hume; Francesco Santoro; Xue Yan; Justin Price; Andrea Natale; Luigi Di Biase
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-16
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Published by Heart Rhythm Society on behalf of Heart Rhythm Society.
Affiliation:
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
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