Rhythm outcomes of minimally-invasive off-pump surgical versus catheter ablation in atrial fibrillation: A meta-analysis of reconstructed time-to-event data

Baudo, Massimo; Petruccelli, Rocco Davide; D'Alonzo, Michele; Rosati, Fabrizio; Benussi, Stefano; Bacco, Lorenzo Di; Muneretto, Claudio

doi:10.1016/j.ijcard.2023.02.008

Cited by 9 publications

(10 citation statements)

References 48 publications

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“…29 The benefit of hybrid ablation over catheter ablation alone is further documented by several meta-analyses. [30][31][32] Given these data, we should anticipate increased uptake among surgeons in the coming years.…”

Section: Tale Of Two Trials In Support Of Hybrid Ablation For Persist...mentioning

confidence: 99%

Noteworthy in Cardiothoracic Surgery 2023

Rove,

Cain,

Hoffman

et al. 2024

Semin Cardiothorac Vasc Anesth

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Noteworthy in Cardiothoracic Surgery 2023 summarizes a few of the most high-impact trials and provocative trends in cardiothoracic surgery and transplantation this past year. Transplantation using organs procured from donation after circulatory death (DCD) continues to increase, and the American Society of Transplant Surgeons released recommendations on best practices in 2023. We review a summary of data on the impact of DCD on heart and lung transplantation. There has been increased interest in extracorporeal life support (ECLS), particularly after the COVID-19 pandemic, and we review the results of the highly discussed ECLS-SHOCK trial, which randomized patients in cardiogenic shock with planned revascularization to ECLS vs usual care. With improving survival outcomes in complex aortic surgery, there is a need for higher-quality evidence to guide which cooling and cerebral perfusion strategies may optimize cognitive outcomes in these patients. We review the short-term outcomes of the GOT ICE trial (Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest), a multicenter, randomized controlled trial of three different nadir temperatures, evaluating outcomes in cognition and associated changes in functional magnetic resonance imaging. Finally, both the Society of Thoracic Surgeons (STS) and the American College of Cardiology, American Heart Association, American College of Chest Physicians and Heart Rhythm Society (ACC/AHA/ACCP/HRS) updated atrial fibrillation guidelines in 2023, and we review surgically relevant updates to the guidelines and the evidence behind them.

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Section: Tale Of Two Trials In Support Of Hybrid Ablation For Persist...mentioning

confidence: 99%

Noteworthy in Cardiothoracic Surgery 2023

Rove,

Cain,

Hoffman

et al. 2024

Semin Cardiothorac Vasc Anesth

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“…This is of paramount importance since this structure should be managed for stroke prevention but also for electrical isolation, thus improving results of AF interventions ( 35 ). These aspects explain the higher success rates in terms of stable sinus rhythm restoration reported after surgical AF ablation when compared to CA ( 36 ).…”

Section: Hybrid Treatment Of Afmentioning

confidence: 99%

Hybrid strategies for stand-alone surgical ablation of atrial fibrillation

Rosati,

Baudo,

D’Alonzo

et al. 2024

Ann Cardiothorac Surg

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Atrial fibrillation (AF) has been reported as a major cause of cardiac morbidity and mortality, and significantly reduces the quality of life in symptomatic patients. Current guidelines recommend antiarrhythmic drugs and catheter ablation (CA) as first-line therapy. Despite CA showed to be associated with lower incidence of peri-procedural complications, rhythm outcomes are far from optimal. Indeed, patients undergoing CA frequently require multiple AF ablation procedures, especially in those with persistent and long-standing persistent AF. While surgical ablation can provide transmural lesions, surgical invasiveness has limited the widespread use of this approach due to the increased perioperative complications. The development of minimally invasive thoracoscopic approaches has renewed the interest towards surgical ablation, thus favoring more simplified ablation sets. Therefore, the concept of “hybrid” ablation has emerged in order to theoretically enhance advantages of both minimally invasive and CA procedures while seeking to improve rhythm outcomes and reduce invasiveness and incidence of perioperative complications. On one hand, it provides the effectiveness of a surgical ablation, on the other, electrical mapping during CA can identify and treat any ablation gap or provide additional ablation lines, thus improving the chance of a stable sinus rhythm restoration at long-term follow-up. Three main thoracoscopic strategies are currently available. All of them can be performed in conjunction with the “catheter ablation procedure”: the “Fusion” technique, the bipolar clamp technique, and the most recent “convergent” technique. CA can be performed either simultaneously or with a staged approach after a blanking period in order to allow the ablation lesion to stabilize. Excellent results of the hybrid procedures have been reported in terms of rhythm outcomes and incidence of perioperative complications. This narrative review aims to discuss the rationale behind the concept of hybrid ablation for the treatment of AF regarding different available strategies, results and expert opinions.

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“…Over the past years, several meta-analyses have discussed rhythm and safety outcomes following hybrid AF ablation ( 34 - 40 ) ( Table 1 ). Based on these studies, the overall success rate of a hybrid AF procedure, in terms of freedom from ATA recurrences until twelve months post-procedure off AAD, varies between 59–88%.…”

Section: Efficacy and Safety Of Hybrid Af Ablation In Meta-analysesmentioning

confidence: 99%

“…Based on these studies, the overall success rate of a hybrid AF procedure, in terms of freedom from ATA recurrences until twelve months post-procedure off AAD, varies between 59–88%. Due to the scarcity of available randomized controlled trials (RCTs), these efficacy outcomes were mostly based on single arm studies (either an observational or trial design) of patients undergoing hybrid AF ablation and in some studies compared to surgical epicardial AF ablation alone ( 37 ) or percutaneous endocardial AF ablation ( 34 ). Importantly, marked statistical and clinical heterogeneity between studies was present.…”

Section: Efficacy and Safety Of Hybrid Af Ablation In Meta-analysesmentioning

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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Rhythm outcomes of minimally-invasive off-pump surgical versus catheter ablation in atrial fibrillation: A meta-analysis of reconstructed time-to-event data

Cited by 9 publications

References 48 publications

Noteworthy in Cardiothoracic Surgery 2023

Noteworthy in Cardiothoracic Surgery 2023

Hybrid strategies for stand-alone surgical ablation of atrial fibrillation

Hybrid atrial fibrillation ablation

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