Abstract 11652: A Prospective Observational Review of Patients Undergoing the Novel ‘TS’ Approach to the Hybrid Atrial Fibrillation Procedure
Introduction: Historically, persistent atrial fibrillation (PeAF) and long standing persistent atrial fibrillation (LSPeAF) have been difficult to ablate with poor success rates despite multiple procedures. The advent of Hybrid AF procedures has improved success. However, endovascular mapping/ablation can be limited by edema when following an epicardial ablation. Therefore, we propose an alternative technique that emphasizes an endovascular first approach, transcatheter (T) preceding surgical (S).
Hypothesis: Hybrid AF success rates can be increased for both PeAF and LSPeAF by the ‘TS’ Hybrid AF procedure defined by a comprehensive endovascular approach preceding and guiding the epicardial ablation which includes an extensive posterior wall ablation.
Methods: We prospectively enrolled 31 patients over 24 months in a single center with the procedure performed over 24 hrs. Patients had a mean AF duration of 7 ± 4 years with 32% (n=10) having undergone prior ablations. Mean age was 64 ± 8 years with mean LA size of 4.87 ± 0.8 cm. The endovascular procedure remained uniform with antral PVI, posterior LA roof and right atrial CTI linear lesions and mapping/ablation of LA CFAEs and existing atrial arrhythmias. The epicardial procedure included a thorascopic Cox Maze-IV approach with GP mapping/ablation, creation/filling of LA posterior box, directed CFAE ablation and LAA ligation. For follow up, 77% (n=24) of patients received ICMs and 23% (n=7) received 7-day continuous AECG at 3-month intervals for 1 year.
Results: Thirty-one patients, 77% (n=24) PeAF and 23% (n=7) LSPeAF have had this procedure with no major complications. Antiarrhythmics were discontinued at 3 ± 3 months. Fifteen patients were followed for ≤ 12 months with 93% (n=14) having no recurrences as defined by any atrial arrhythmia ≤ 30 sec and 7% (n=1) having a self-terminating atrial tachycardia not requiring antiarrhythmics or repeat procedure. Sixteen patients monitored < 1 year are arrhythmia free.
Conclusion: The ‘TS’ approach demonstrated a compelling single procedure success rate of 93% supported by extensive monitoring. A comprehensive endovascular study guiding the epicardial ablation along with an extensive posterior wall ablation presumably contributed to this high success rate.
Author Disclosures: J.J. Tiano: Consultant/Advisory Board; Modest; AtriCure, St. Jude Medical. A. DiMeo: None. L. Scierka: None. R. Squitieri: None.
- © 2014 by American Heart Association, Inc.