Breakthroughs in hybrid management of stand-alone AF.

Abstract

based on the following inclusion criteria: studies with more than ten patients, follow-up of more than three months, minimally invasive beating heart surgery and transcatheter ablation either staged or as a single procedure for the treatment of lone AF. The total number of patients was 335, and 114 (34%) of them had undergone one or more previous endocardial catheter ablation procedures. One hundred and four (31%) had persistent AF and 162 (48%) long-standing persistent AF. Several procedural techniques were analyzed. One study reported on the results employing a sequential approach, combining minimally invasive surgical ablation followed 3 to 5 days later by endocardial catheter ablation. In two studies, a staged approach was described with a catheter procedure 30 to 45 days after the surgical ablation. The 6 remaining studies described a combined approach during which the endocardial catheter ablation followed the epicardial surgical ablation during the same procedure. In 4 studies, bipolar radiofrequency (RF) was used as the epicardial energy source and in five studies, monopolar RF was employed. The only lesion that was common to all included patients was PV isolation. Several other left and right linear lesions were reported in these studies but only a few papers described their use in detail. In all included studies, a minimum follow-up period of 12 months was reported with the use of at least one method of long-term monitoring. The adapted protocol for the use of antiarrhythmic drugs (AAD) and oral anticoagulation during the follow-up period was quite dissimilar between included studies. In all studies, the primary efficacy endpoint was defined according to the current guidelines, freedom from AF off AAD at 1-year follow-up. Regarding the energy source used during the epicardial surgical procedure, success rates ranged from 86% to 92% in patients treated with bipolar RF and from 37% to 89% in patients managed