Hybrid Ablation for Atrial Fibrillation: Safety &amp; Efficacy of Unilateral Epicardial Access

Pong, Terrence; Shah, Roshni; Carlton, Cody; Truong, Angeline; Fann, Beatty E.; Cyr, Kevin; Aparicio‐Valenzuela, Joy; Brodt, Chad; Wang, Paul J.; Lee, Anson M.

doi:10.1053/j.semtcvs.2022.03.003

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…Third, we opted for a single, left-sided, access, as previous reports have also suggested that the unilateral approach not only has no appreciable detrimental effects on the overall success of the hybrid procedure but may also be associated with increased pulmonary tolerance and a significantly shorter LOS. 24 Similarly, epicardial lesions such as superior to inferior vena cava linear ablation typically achieved through a right lateral approach do not significantly affect recurrence of atrial arrhythmias in the short term and are best addressed through a cavotricuspid flatter line ablation performed at the time of endocardial completion. 22 Moreover, camera tridimensional magnification and intrathoracic 360° robotic instruments articulation allow for decreased rib traumatic injury, more precise identification and dissection of targeted anatomic structures, as well as safer navigation through pericardial adhesions of either inflammatory or post-sternotomy origin, as we found in 7 of our patients.…”

Section: Discussionmentioning

confidence: 99%

Robotic-enhanced hybrid ablation for persistent and long-standing atrial fibrillation: Early assessment of feasibility, safety, and efficacy

Schena,

Lindemann,

Carlson

et al. 2024

JTCVS Techniques

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Section: Discussionmentioning

confidence: 99%

Robotic-enhanced hybrid ablation for persistent and long-standing atrial fibrillation: Early assessment of feasibility, safety, and efficacy

Schena,

Lindemann,

Carlson

et al. 2024

JTCVS Techniques

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“…A total of seven studies were included in this analysis (49)(50)(51)(52)(53)(54)(55), five studies reported freedom from ATA recurrence allowing AAD (49,51,(53)(54)(55) and five studies reported freedom from ATA recurrence off AAD (50)(51)(52)(53)55). The resulting K-M curve representing the real-world outcome after hybrid AF ablation on and off AAD is presented in Figure 6.…”

Section: Efficacy and Safety Of Hybrid Af Ablation In Realworld Datamentioning

confidence: 99%

Hybrid atrial fibrillation ablation

van der Heijden,

Aerts,

Chaldoupi

et al. 2024

Ann Cardiothorac Surg

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In this state-of-the art review on hybrid atrial fibrillation (AF) ablation, we briefly focus on the pathophysiology of AF, the rationale for the hybrid approach, its technical aspects and the efficacy and safety outcomes after hybrid AF ablation, both from meta-analyses and randomized control trial data. Also, we performed a systematic search to provide a provisional overview of real-world hybrid AF ablation efficacy and safety outcomes. Furthermore, we give an insight into the ‘Maastricht approach’, an approach that allows us to tailor the ablation procedure to the individual patient. Finally, we reflect on future perspectives with the objective to continue improving our thoracoscopic hybrid AF ablation approach. Based on the review of the available literature, we believe it is fair to state that thoracoscopic hybrid AF ablation is a valid alternative to catheter ablation for the treatment of patients with more persistent forms of AF.

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“…A convergent approach to AF ablation has been described in several small studies (11,13,14,(16)(17)(18)(19) as well as a recent meta-analysis (10) and randomised controlled trial (RCT) (12). They report very favourable rates of maintenance of sinus rhythm in the medium and long term.…”

Section: Procedural Outcomes and Safetymentioning

confidence: 99%

“…Subsequent endocardial studies are then used to confirm posterior wall isolation and further radiofrequency endocardial lesions delivered to complete PVI. Though relatively new with few published studies, it seems to offer significant promise in treating PsAF (10)(11)(12)(13), although a significant increase in periprocedural complications is reported compared with endocardial CA alone (10,(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Convergent approach to persistent atrial fibrillation ablation: long-term single-centre safety and efficacy

Carpenter,

Pannell,

Rizvi

et al. 2024

Front. Cardiovasc. Med.

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BackgroundEfforts to maintain sinus rhythm in patients with persistent atrial fibrillation (PsAF) remain challenging, with suboptimal long-term outcomes.MethodsAll patients undergoing convergent PsAF ablation at our centre were retrospectively analysed. The Atricure Epi-Sense® system was used to perform surgical radiofrequency ablation of the LA posterior wall followed by endocardial ablation.ResultsA total of 24 patients underwent convergent PsAF ablation, and 21 (84%) of them were male with a median age of 63. Twelve (50%) patients were obese. In total, 71% of patients had a severely dilated left atrium, and the majority (63%) had preserved left ventricular function. All were longstanding persistent. Eighteen (75%) patients had an AF duration of >2 years. There were no endocardial procedure complications. At 36 months, all patients were alive with no new stroke/transient ischaemic attack (TIA). Freedom from documented AF at 3, 6, 12, 18, 24, and 36 months was 83%, 78%, 74%, 74%, 74%, and 61%, respectively. There were no major surgical complications, with five minor complications recorded comprising minor wound infection, pericarditic pain, and hernia.ConclusionsOur data suggest that convergent AF ablation is effective with excellent immediate and long-term safety outcomes in a real-world cohort of patients with a significant duration of AF and evidence of established atrial remodelling. Convergent AF ablation appears to offer a safe and effective option for those who are unlikely to benefit from existing therapeutic strategies for maintaining sinus rhythm, and further evaluation of this exciting technique is warranted. Our cohort is unique within the published literature both in terms of length of follow-up and very low rate of adverse events.

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Hybrid Ablation for Atrial Fibrillation: Safety & Efficacy of Unilateral Epicardial Access

Cited by 7 publications

References 24 publications

Robotic-enhanced hybrid ablation for persistent and long-standing atrial fibrillation: Early assessment of feasibility, safety, and efficacy

Robotic-enhanced hybrid ablation for persistent and long-standing atrial fibrillation: Early assessment of feasibility, safety, and efficacy

Hybrid atrial fibrillation ablation

Convergent approach to persistent atrial fibrillation ablation: long-term single-centre safety and efficacy

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