Abstract
BackgroundThe hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF).MethodsBetween June 2009 and December 2010 nineteen consecutive patients (mean 60.8 ± 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines.ResultsThere were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3–47.4) at two weeks, was 30.4% (27.3–34.9) at three months, fell to 14.2% (11.6–18.1) by 6 months and was 13.3% (11.0–17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4–33.1) and 48% (37.2–53.2), respectively.ConclusionsOne year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.
Highlights
The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure
We have recently introduced a less-invasive hybrid single-sided approach through a right thoracoscopy and, as far as we know, there are no reports in the literature about the effectiveness of this procedure
lone atrial fibrillation (LAF) was defined as suggested by American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ ESC) Guidelines [11] and updated ESC Guidelines were followed to distinguish the type of AF and to score the AF-related symptoms (European Heart Rhythm Association [EHRA] score) [12]
Summary
The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. A sequential one-step surgical/catheterbased approach has been introduced showing satisfactory results in patients with persistent LAF [9]. This so-called hybrid procedure combines the advantages of PCA and video-assisted thoracoscopic epicardial procedures and it is expected to overcome the shortcomings of these techniques [10]. We have recently introduced a less-invasive hybrid single-sided approach through a right thoracoscopy and, as far as we know, there are no reports in the literature about the effectiveness of this procedure.
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