Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients

Abstract

Background: We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial ablation technique for the treatment of atrial fibrillation (AF) in obese versus non-obese patients.Methods: Between January 2010 and January 2015, a cohort of 61 patients were retrospectively identified to undergo ablation of AF as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3, 6 months, 1 year and yearly thereafter.Results: A total of 40% of the obese cohort had persistent or long-standing AF, compared to 54.9% of the non-obese cohort. There were no deaths or conversion to cardiopulmonary bypass required. At 3-year follow-up, 60% of the obese group were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting 30 s off anti-arrhythmic drugs. This was compared to 70.6% in the non-obese group, with no significant difference between the groups (P=0.468). For success rates on anti-arrhythmic drugs, this was 80% in the obese group compared to 86% in the non-obese group at 3-year follow-up (P=0.637). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up. Conclusions:In a retrospective cohort with approximately half with persistent or long-standing AF, thoracoscopic hybrid epicardial endocardial ablation proved to be equally effective and safe in obese versus non-obese patients. Current preliminary findings require further validation in multi-institutional prospective studies with larger sample sizes.

Long-Term Outcome after Convergent Procedure for Atrial Fibrillation

“…Since then, no atrio-esophageal fistulas or deaths occurred. Our results are consistent with previous research, which show major complication rate after CP between 0 and 20.8%, with a pooled complication rate of 5.53% (16,(33)(34)(35). In a single center study Larson et al…”

Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: a systematic review and meta-analysis of randomised control trials and propensity matched studies

“…There is also a paucity of evidence exploring the efficacy of convergent ablation in high-risk patients such as those with a high BMI and a previous history of cardiac surgery. Obese patients face greater risks of complications from ablation procedures due to their comorbidities p 31 ]. During hybrid ablation, haemodynamic intolerance, stroke risk and ventilation may pose an issue [ 31 ].…”

“…Obese patients face greater risks of complications from ablation procedures due to their comorbidities p 31 ]. During hybrid ablation, haemodynamic intolerance, stroke risk and ventilation may pose an issue [ 31 ]. Additionally, procedure times are usually longer and radiation exposure greater in obese patients [ 31 ].…”

“…During hybrid ablation, haemodynamic intolerance, stroke risk and ventilation may pose an issue [ 31 ]. Additionally, procedure times are usually longer and radiation exposure greater in obese patients [ 31 ]. Furthermore, the presence of epicardial fat may attenuate the energy delivered to the left atrial wall, diminishing the effectiveness of the procedure.…”

“…Furthermore, the presence of epicardial fat may attenuate the energy delivered to the left atrial wall, diminishing the effectiveness of the procedure. These difficulties have not translated to a lower FFAF following thorascopic ablation [ 31 , 32 ]. Patients with a previous history of cardiac surgery may have adhesions limiting exposure of the left atrium, and in which case the procedure may not be feasible.…”