Hybrid ablation procedure for the treatment of nonparoxysmal atrial fibrillation: A systematic review and meta-analysis.

Abstract

Hybrid ablation combines the advantages of surgical and catheter ablation. Many studies have explored the efficiency and safety of hybrid ablation in patients with nonparoxysmal AF. We systematically searched for prospective controlled trials that compared hybrid ablation with catheter/surgical ablation in PubMed, Web of Science, Wiley Library, and CNKI. Our main assessment indicators included maintenance of sinus rhythm (SR) without antiarrhythmic drugs for more than 12 months, major adverse events (MAEs), procedure time and fluoroscopy time. Of 1214 identified studies, five were eligible and were included in our analysis (N=451 participants). The pooled results showed that hybrid ablation was more effective in maintaining SR than a single procedure (surgical ablation or catheter ablation) (OR=2.52, 95% confidence interval [CI]: 1.63-3.89, p<.001). Little significant heterogeneity was revealed (p=.32 for heterogeneity, I2 =14%). More MAEs occurred in the hybrid group than in the single procedure group (OR=7.47, 95% CI: 1.90-29.41, p=.004; I2 =0%). Two trials reported the procedure and fluoroscopy times, and the procedure time for hybrid ablation was significantly longer than that of a single procedure (mean difference=107.42, 95% CI: 88.62 to 126.22, p<.001; I2 =82%). There was no significant difference in fluoroscopy time between the 2 groups (mean difference=-1.00, 95% CI: -5.37 to 3.36, p=.65; I2 =12%). Hybrid ablation was more effective than catheter ablation and was as effective as surgical ablation in patients with nonparoxysmal AF. Meanwhile, hybrid ablation, especially concomitant hybrid ablation, increases the incidence of MAEs and prolongs the procedure time.