B-PO05-092 RIGHT MINI-THORACOTOMY SURGICAL COX-MAZE IV (LEFT ATRIAL LESION SET) VS CATHETER ABLATION USING CONTACT FORCE-SENSING TECHNOLOGY IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION

Abstract

Pulmonary vein isolation (PVI) often is not sufficient in patients (pts) with persistent atrial fibrillation (PAF). Substrate modification (SM) by catheter ablation (CA) of low-voltage zones (LVZ) has yielded favorable results, but those studies were performed before the introduction of contact force (CF) sensing technology. Surgical ablation (SA) studies support the hypothesis that Cox Maze IV procedure is able to improve success, but there is less data on outcome of pts undergoing left atrial (LA) linear lesions alone. In this single-center retrospective study, we analyzed the long-term outcomes of CA and SA in PAF. In the CA group, pts underwent PVI and additional SM in the presence of LVZ (roof and supero-septal lines) using CF catheters. In the SA group, pts underwent ablation procedure (Cox Maze IV LA endocardial lesion set) performed by a right mini-thoracotomy approach using the Atricure™ cryoablation probe and mitral valve repair in the presence of severe mitral valve regurgitation. 196 pts were included. 120 pts underwent CA (median age 65 [58-72] yrs, median LA volume index (LAVI) 66 [56-75] ml/m2), in pts with LVZs PVI + SM was performed (bidirectional block of lines in 100%). 76 pts underwent SA (median age 64 [58-74] yrs, median LAVI 90 [78-103] ml/m2), in pts mitral valve repair was performed. At 24 months (figure), 89% and 68% of pts were free of AF in the SA and CA group, respectively, mainly without antiarrhythmic drugs (92% SA group, 89% CA group). In PAF, SA performed by a right mini-thoracotomy approach with linear lesions limited to LA leads to excellent 2-year freedom from AF despite significantly larger LAVI compared to the CA group.