Hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation

Objective To explore the application and effectiveness of one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF). Methods From Jun 2015 to Dec 2017, a cohort of 56 patients[18 female, mean age of(59.1±6.9) years] with long-standing persistent atrial fibrillation underwent one-staged(30 cases) or two-staged(26 cases) hybrid minimally invasive surgical and transcatheter ablation. Mean AF duration was(5.9±3.0) years. Mean left atrial diameter was(45.4±4.2)mm. Mean CHA2DS2-VASc score was 2.3±1.2. Fourteen cases had a history of prior catheter ablation. All patients underwent continuous 24-hour or 48-hour holter monitoring at 3 months, 6 months, 1 year and yearly thereafter. Results All patients successfully underwent one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation. During ablation, LSPAF was terminated in 80.0%(24/30) with one-staged hybrid ablation and 84.6%(22/26) with two-staged hybrid ablation. At a mean follow-up of(20.3±8.2) months, 89.3%(50/56) patients maintained sinus rhythm. Among them, 86.7%(26/30) patients with one-staged hybrid ablation maintained sinus rhythm, and 92.3%(50/56) patients with two-staged hybrid ablation maintained sinus rhythm. Six patients with recurrent AF continued to receive warfarin and amiodarone drug therapy. No death or cerebrovascular events occurred. No patient required permanent pacemaker implantation. Conclusion One-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF. The early and midterm outcomes were satisfactory. Key words: Long-standing persistent atrial fibrillation; Hybrid surgery; Minimally invasive surgical ablation; Transcatheter ablation