Treatment of persistent atrial fibrillation(AF) and severe left atrial(LA) dilatation is often unsuccessful, using both minimally invasive surgical or catheter procedures alone. To overcome the limitations of both techniques, we investigated the effectiveness of a staged hybrid method consisting in a right thoracoscopic ablation with the Cobra Fusion system, followed by a percutaneous Rhythmia system mapping/ablation, 2 months later.
Twenty consecutive patients(age57 ± 7.6years, 17males, BMI 30 ± 3.0Kg/m2, LVEF52 ± 8.2%) with lone symptomatic, refractory, persistent (80%) or long-standing persistent (20%) AF and severely dilated LA (volume index 47 ± 8.9 ml/m2 at echocardiography, 73 ± 16.4 ml/m2 at CT scan) were treated with this staged approach. An Implantable Loop Recorder (ILR) was implanted at the end of the operation.
No hospital or late deaths occurred. The 1-year freedom from AF recurrence was 85 ± 8.0% and from AF recurrence off class I/III antiarrhythmic drugs (AADs) was 75 ± 9.7%. At 12 months, the proportion of patients in SR was 80%, of whom 73% were in stable SR off class I/III AADs. At last follow-up, no stroke and thromboembolic events were documented, all pts were in class EHRA I, LVEF improved from 52 ± 8.2% at baseline, to 58 ± 2.3% (p = 0.01) and median LA volume index decreased from 48 ml/m2 (IQR 43;53) to 33 ml/m2 (IQR 25;35)(p = 0.001).
This staged hybrid approach yields promising results in selected patients with persistent/long-standing persistent AF and severely dilated left atrium who are at very high risk of AF recurrence. The LA mapping, the use of ILR monitoring and the clinical/echocardiographic follow-up performed in our dedicate AF center, further reinforce the reliability of these results.
1Cardiochirurgia, IRCCS Ospedale San Raffaele Milano
2Aritmologia, IRCCS Ospedale San Raffaele Milano
3Anestesia e Rianimazione, IRCCS Ospedale San Raffaele Milano
4Cardiologia, IRCCS Ospedale San Raffaele Milano