Abstract 12964: Staged versus Same-Day Thoracoscopic Hybrid Ablation for Persistent Atrial Fibrillation: Identification of Pulmonary Vein Reconnection Following Surgical Ablation
Introduction: Totally thoracoscopic (TT) epicardial ablation combined with endocardial catheter ablation is an emerging approach to treat persistent atrial fibrillation (AF). Catheter ablation is associated with frequent pulmonary vein (PV) reconnection bringing its durability into question despite acute procedural endpoints. Little is known of PV reconnection post TT PV isolation (PVI). Endocardial mapping following TT PVI may shed light on when best to identify PV reconnections.
Hypothesis: A staged approach to TT hybrid AF ablation increases the likelihood of discovering PV reconnection compared to same day hybrid, allowing time for resolution of edema and inflammation which transiently impede PV conduction after surgical ablation.
Methods: We compared efficacy of thoracoscopic PVI in persistent AF patients undergoing same day vs. staged (>48 Hr delay) hybrid AF ablation at Vanderbilt Hospital. Univariate and multivariate analysis was performed comparing patients with any PV reconnection vs. those with complete PV isolation (0/4 reconnection) after TT PVI.
Results: 83 persistent AF patients (52 same day, 31 staged) underwent hybrid ablation. The median age of the patients was 63 years (interquartile range 55,67.5), median LVEF 55% (51%,60%), median left atrial size 49mm (42,53). Median delay between procedures in the staged group was 75 days (interquartile range 5-123). At endocardial mapping, any PV reconnection was found in 13.5% (7/52) of patients in the same day group versus 48.4% (15/31) in the staged group. In univariate analysis, a staged approach increased the likelihood of detection of PV reconnection (OR 6 [2-17], p=0.001). In multivariate analysis, staged hybrid remained highly associated with detection of PV reconnection adjusted for age, LA size and LVEF. Of patients with any PV reconnection after TT PVI 72.7% (16/22) had only one PV reconnect. No patient had > 2 PVs connect after TT PVI.
Conclusions: Hybrid thoracoscopic ablation for persistent AF using a staged approach significantly increases the likelihood of discovering PV reconnection during endocardial mapping versus a same day procedure. 48.4% of patients in the staged group show PV reconnection emphasizing the need to map endocardially to complete the hybrid AF lesion set.
Author Disclosures: C.R. Ellis: Research Grant; Significant; Thoratec, Heartware, Boston Scientific, Boehringer Ingelheim. Honoraria; Modest; Boston Scientific, Medtronic Inc.. Consultant/Advisory Board; Modest; Atricure. T.D. Richardson: None. M.B. Shoemaker: None. S.P. Whalen: Consultant/Advisory Board; Modest; Atricure, Biotronik. S.J. Hoff: Consultant/Advisory Board; Modest; Atricure.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.