Vnitr Lek 2022, 68(5):E20-E26 | DOI: 10.36290/vnl.2022.069

Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation

Martin Pešl^{1, 2, 3}, Tomáš Kulík^{1, 2}, Tomáš Ostřížek⁴, Vladimír Horváth⁴, Filip Souček^{1, 2}, Katarína Melajová¹, Katarína Doležalová¹, Daniela Žáková⁴, Tomasz Jadczyk^{2, 5}, František Lehar¹, Jiří Jež^{1, 2}, Zdenek Stárek^{1, 2}

¹ I. interní kardioangiologická klinika, Fakultní nemocnice u sv. Anny v Brně, Lékařská fakulta Masarykovy univerzity, Brno

² Mezinárodní centrum klinického výzkumu (ICRC), Fakultní nemocnice u sv. Anny v Brně

³ Biologický ústav, Lékařská fakulta Masarykovy univerzity, Brno

⁴ Centrum kardiovaskulární a transplantační chirurgie (CKTCH), Brno

Introduction: Single stage thoracoscopic radiofrequency ablation (RFA) is a treatment method for persistent and long-term persistent atrial fibrillation (AF) offering the possibility for patients otherwise inconsolable by conventional catheter RFA. We present a pilot group of patients after the introduction of the new method at our clinical center. Patients group: A total of 52 patients aged 61.82 ± 9.7 years underwent single stage hybrid ablation (thoracoscopic isolation of pulmonary veins and box lesion followed by catheter verification of the surgical procedure effectivness) for symptomatic persistent and long-term persistent AF with significantly dilated left atrium 57.9 ± 11.0mm in the period September 2016-March 2019.

Results: The median duration of the procedure was 232 minutes and the median duration of hospitalization was 10 days. At discharge, 52 patients (100%) had sinus rhythm. 48 of 52 patients (92.3%) had a 6-month follow-up. 41 of 48 (85.4%) and 38 of 44 (86.4%) of patients were AF free at 3-month and 6-month follow-up, respectively. Acute complications were: one left atrial perforation resolved successfully by suture and one transient ischaemic attack without permanent sequelae. Late complications involved one massive pulmonary embolization and an atrioesophageal fistula. There was no periprocedural myocardial infarction or stroke with permanent sequelae.

Conclusion: Hybrid thoracoscopic-catheter ablation performed during one procedure is an effective and relatively safe mini-invasive method of treatment for long-term persistent atrial fibrillation.

Keywords: persistent atrial fibrillation, catheter ablation, thoracoscopic ablation, hybrid single stage ablation.

Accepted: August 5, 2022; Published: August 22, 2022  Show citation