Abstract 12595: Hybrid Surgical and Catheter Ablation of Atrial Fibrillation: Comparison of Techniques
Introduction: Hybrid catheter/surgical ablation (HyCASA) of AF may be more effective than endocardial (endo) ablation (abl) in pts with history of failed ablation or structural heart disease.
Hypothesis: There may be difference in the many approaches to HyCASA abl.
Methods: In 38 pts with long-standing pers (LSP) (3), pers (25), or parox (10) AF, trans-abdominal HyCASA was performed with epicardial (epi) unipolar RF (nContact VisiTrax, Morrisville, NC). Then in 29 pts with LSP (5), pers (22), or parox (2) AF right trans-thoracic HyCASA was performed with epi bipolar/unipolar RF (AtriCure Fusion, West Chester, OH). Epi isolation of pulmonary veins, posterior LA, and posterior RA was followed by endo abl including completion of epi lesion set, CFAE, and any residual flutter ablation. Any AF > 2 min found by continuous monitoring (ILR or PM/ICD in all pts) after a 3-mo blanking period was considered a recurrence.
Results: Age was 61.8 (9.6, mean+SD); 79% were male. Co-morbidities included HTN (75%), DM (29%), CAD (18%), HF (25%), and obesity (BMI>30) (69%). LA size was 4.9 (0.7) (range: 3.3-6.8) cm; EF was 51.9 (10.2) (range 15-70) %. AF duration was 6.4 (5.7) (range: 0.5-25) yrs. All had failed drug therapy and 46% had failed prior endo abl (1.5 abl/pt). Pts undergoing HyCASA using thoracic/AtriCure approach were more likely pers (93% vs 74%, p=.04). There was no other difference between groups. Hospital length of stay was longer (7.0 vs 3.7 days, p<.001) and there were more bleeding complications (3 vs 0, p=.04) in the thoracic/AtriCure approach. There was no peri-procedural mortality or stroke. At median follow-up of 294 days, success was 72% with the thoracic/AtriCure approach and 53% with the abdominal/nContact approach (p=.10) (Graph).
Conclusions: HyCASA AF ablation with the thoracic/AtriCure compared with the abdominal/nContact approach trends toward better efficacy but has an increased risk for complications and longer hospital length of stay.
Author Disclosures: A. Gehi: Speakers Bureau; Modest; AtriCure, Inc. J.P. Mounsey: Speakers Bureau; Modest; AtriCure, Inc. S. Cherkur: None. A. Kiser: Speakers Bureau; Modest; AtriCure, Inc.
- © 2014 by American Heart Association, Inc.