Hybrid ablation of atrial fibrillation: long-term outcomes from a single center prospective experience

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/introduction Hybrid ablation of atrial fibrillation (AF) is emerging as a new technique for rhythm control with good clinical outcomes, especially in patients with non-paroxysmal AF. However, the role of hybrid AF in redo procedures is not clear. Moreover, long term clinical outcomes studies are lacking. Purpose The aim of this study is to define the long-term clinical outcomes of hybrid AF ablation in a large cohort from a single high-volume center. Furthermore, a correlation between the timing of hybrid AF and the outcomes is aimed. Methods All consecutive patients undergoing to hybrid AF ablation between 2014 and 2020 were enrolled in a prospective fashion. Hybrid ablation was performed in a one-step procedure consisting of: 1) Bilateral thoracoscopic epicardial ablation and 2) Percutaneous mapping and ablation. Pulmonary veins and posterior wall isolation was performed in all patients. Additional lesion set was performed based on physician judgement and clinical indication, including the following: superior vena cava isolation, bicaval line, anterior or posterior mitral line, cavotricuspid isthmus. Hybrid ablation time was analyzed as first hybrid procedure or redo hybrid after previous failed percutaneous procedure. The primary endpoint was defined as freedom from any atrial tachyarrhythmias (ATas) ≥ 30 seconds after a 90-day post-ablation blanking period. Results A total of 120 patients were included, 92 (76.7%) patients with persistent or long-term persistent AF and 28 patients (23.3%) with paroxysmal AF. Hybrid ablation was the first procedure in 85 (70.8%) patients and the second or third procedure (redo or re-redo) in 35 (29.2%) patients. Compared to patients with a second or third hybrid procedure, patients with a first hybrid procedure had more often persistent AF [81 patients (95.3%) vs 11 patients (31.4%), p<0.001]. At a mean follow-up of 52.1 months ± 29.0 there were 36 (30%) ATas recurrences, Figure 1. There was no significant difference in ATas free survival between patients with a first hybrid procedure and patients with a second or third hybrid procedure (69.4% vs 71.4%, Log-Rank p=0.81), Figure 2. Patients with a second hybrid procedure had higher ATas free survival compared to patients with a third hybrid procedure (86.4% vs 46.2%, Log-Rank p=0.01) Conclusion In a large cohort undergoing to hybrid AF ablation, the recurrence rate was 30% at a long-term follow-up of more than 4 years. Timing is of utmost clinical importance as delaying hybrid approach might be associated with worse clinical outcome.