Long-term outcome of thoracoscopic ablation and radiofrequency catheter ablation for persistent atrial fibrillation as a de novo procedure

Abstract

Aims Limited data are available regarding the efficacy of thoracoscopic ablation as the first procedure for persistent atrial fibrillation (AF). We sought to compare the long-term efficacy of thoracoscopic ablation vs. radiofrequency (RF) catheter ablation as the first procedure for persistent AF. Methods and results Between February 2011 and December 2020, 575 patients who underwent ablation for persistent AF were studied. Among them, thoracoscopic ablation was performed in 281 patients, RF catheter ablation in 228, and hybrid ablation in 66. Rhythm, clinical, and safety outcomes during 7-year follow-up were compared. The patients who underwent thoracoscopic ablation were older, had a higher prevalence of stroke, and had a larger left atrial volume than those who underwent RF catheter ablation. In the propensity score-matched population (n = 306), incidences of atrial tachyarrhythmia recurrence were 51.4% in the thoracoscopic ablation group and 62.5% in the RF catheter ablation group [adjusted hazard ratio (HR) 0.869, 95% confidence interval (CI) 0.618–1.223, P = 0.420]. Stroke and total procedural adverse events were not significantly different between thoracoscopic and RF catheter ablation (2.7 vs. 2.5%, P = 0.603, and 7.1 vs. 4.8%, P = 0.374, respectively). The hybrid ablation group showed similar rhythm outcomes compared with both the thoracoscopic and the RF catheter ablation groups. At the redo procedure, pulmonary vein gaps were more frequently observed in the RF catheter ablation group (32.6%) than in the thoracoscopic ablation group (7.9%) and in the hybrid ablation group (8.8%) (P < 0.001). Conclusion As a first procedure in persistent AF, thoracoscopic ablation and RF catheter ablation showed comparable efficacy, clinical, and safety outcomes during long-term follow-up.

2023 APHRS expert consensus statements on surgery for AF

“…80 Other comparative studies of the propensity score-matched population of thoracoscopic ablation or radiofrequency catheter ablation performed for persistent atrial fibrillation as the first ablative procedure have shown that there is no significant deference in the long-term incidence of tachyarrhythmia recurrence between the two procedures. [85][86][87] Hybrid ablation approach, defined as a bilateral PVI with LAA closure to be performed surgically combined with percutaneous catheter-base endocardial ablation, 3 has been shown to provide better results compared with percutaneous catheter ablation alone in symptomatic AF patients who have failed medical and percutaneous treatment. 88 The procedure may be indicated in a subgroup of symptomatic paroxysmal AF patients with a small LA in whom pharmacological therapy and percutaneous ablation have failed, while the optimal ablation device and approach, the timing of catheter ablation, and other factors are still controversial.…”

“…Patients with a dilated left atrium with or without hypertension were also included in the comparative study; however, no significant efficacy of surgical ablation was demonstrated over catheter ablation 80 . Other comparative studies of the propensity score‐matched population of thoracoscopic ablation or radiofrequency catheter ablation performed for persistent atrial fibrillation as the first ablative procedure have shown that there is no significant deference in the long‐term incidence of tachyarrhythmia recurrence between the two procedures 85–87 …”

“… 80 Other comparative studies of the propensity score‐matched population of thoracoscopic ablation or radiofrequency catheter ablation performed for persistent atrial fibrillation as the first ablative procedure have shown that there is no significant deference in the long‐term incidence of tachyarrhythmia recurrence between the two procedures. 85 , 86 , 87 …”

Predictive value of valvular calcification for the recurrence of persistent atrial fibrillation after radiofrequency catheter ablation

“…Over the past decade, the heightened occurrence of AF has been an important public health challenge. 1 Radiofrequency catheter ablation (RFCA) has become an important treatment for AF, especially in heart failure (HF). 2 As a type of AF, persistent AF (PsAF) was defined as AF lasting more than 7 days.…”

Thoracoscopic, hybrid, and catheter ablation: comparing apples to oranges to pears

“…In this issue of Europace, Kim et al 7 attempt to address the evidence gap by performing a single-centre retrospective study analysing the incidence of AF recurrence and the composite endpoint of death, stroke, and heart failure hospitalization after performing TA as a stand-alone procedure compared to radiofrequency CA, and hybrid ablation in patients with persistent AF. Among 575 patients included, 281 (49%), 228 (40%), and 66 (11%) underwent TA, CA, and hybrid ablation, respectively.…”