Abstract 20076: Hybrid Approach for Ablation of Atrial Fibrillation - A Systematic Review and Meta-analysis
Introduction: Catheter ablation has been increasingly utilized as an effective rhythm control strategy for atrial fibrillation (AF); although, the durability of results has been variable. The hybrid approach (joint surgical and catheter ablation) is an emerging technique with several studies demonstrating promising results.
Methods: A systematic literature review was conducted to March 2013 using PUBMED/EMBASE. Broad search terms included “Cox-Maze, Mini-Maze, ablation methods (including RF, cryoablation, cryomaze), surgery and hybrid”. This yielded 3637 results with abstracts reviewed to remove studies that did not pertain to hybrid ablation. A total of 116 full-text articles were assessed with 9 suitable studies included for analysis.
Results: The 9 included studies comprised of 6 case series and 3 prospective studies with a mean follow up of 17±9 months and overall cohort of 271 patients (17% paroxysmal, 24% persistent & 59% longstanding persistent). All studies utilized radiofrequency as the energy source for surgical ablation with base lesion sets of pulmonary vein isolation or box lesions. Additional lesion sets were variable. Three studies undertook a sequential approach with immediate follow on to catheter ablation, four studies utilized a staged approach (interval of 4 to 167 days) and 2 had mixture of both approaches. Catheter ablation strategy differed among the studies apart from ensuring the pulmonary veins were isolated. Differing ablation endpoints were used in these studies. Overall sinus rhythm maintenance at the final follow-up was 84.5% with anti-arrhythmic drugs (AAD) while drug free success rate was 70.8%. Success was similar in studies utilizing the staged versus the sequential approach (85.5 vs. 80.7%; p=0.5). Success was higher in those that demonstrated conduction block following ablation (86.4% vs. 73.6%, p=0.04). Overall procedural complication rate was 4.1%: death 1.8%, stroke 1.1%, post-operative bleeding 2.9% and atrioesophageal fistula 1.1%.
Conclusion: The emerging approach of hybrid ablation shows great promise in the management of AF. Future large cohort population studies or randomized control trials are needed to further define the role of this technique.
Author Disclosures: J.A. Varzaly: None. D.H. Lau: None. A. Brooks: None. J. Edwards: None. R. Stuklis: None. M. Worthington: None. P. Sanders: None.
- © 2014 by American Heart Association, Inc.